Philips IntelliVue MX40 User manual

IntelliVue MX40

Instructions for Use

Notice

Proprietary Information

This document contains proprietary information, which is protected by
copyright.

Copyright

Copyright © 2011 Koninklijke Philips Electronics N.V. All rights reserved.
Reproduction in whole or in part is prohibited without the prior written
consent of the copyright holder. Philips Medical Systems Nederland B.V.
reserves the right to make changes in specifications and/or to discontinue any
products at any time without notice or obligation and will not be liable for any
consequences resulting from the use of this publication.

OxiCliq ® and OxiMax ® are registered trademarks of Nellcor Incorporated.

Duracell ® is a registered trademark of Procter & Gamble Incorporated.

STERRAD ® is a registered trademark of Advanced Sterilization Products.

GORE-TEX ® is a registered trademark of W.L. Gore & Assoc. Incorporated

Tone modulation is licensed under US patent 4,653,498 from Nellcor Puritan
Bennett Incorporated.

Manufacturer

Philips Medical Systems
3000 Minuteman Road
Andover, MA 01810-1099

[phone]

Printed in USA

Document number

453 564 242 441

Warranty

The information contained in this document is subject to change without
notice. Philips Medical Systems makes no warranty of any kind with regard to
this material, including, but not limited to, the implied warranties or
merchantability and fitness for a particular purpose. Philips Medical Systems
shall not be liable for errors contained herein or for incidental or consequential
damages in connection with the furnishing, performance, or use of this
material.

ii

FCC

This device complies with Part 15 and/or Part 95 of the FCC Rules. Operation
is subject to the following two conditions: (1) these devices may not cause
harmful interference, and (2) these devices must accept any interference
received, including interference that may cause undesired operation.

Changes and modifications not expressly approved by Philips Medical
Systems can void your authority to operate this equipment under Federal
Communications Commission's rules

Printing History

New editions of this document will incorporate all material updated since the
previous edition. Update packages may be issued between editions and
contain replacement and additional pages to be merged by a revision date at
the bottom of the page. Note that pages which are rearranged due to changes
on a previous page are not considered revised.

The documentation printing date and part number indicate its current edition.
The printing date changes when a new edition is printed. (Minor corrections
and updates which are incorporated at reprint do not cause the date to
change.) The document part number changes when extensive technical
changes are incorporated.

First Edition June 2011

Document Conventions

In this guide:

Warnings

Warning

A Warning alerts you to a potential serious outcome, adverse event or safety
hazard. Failure to observe a warning may result in death or serious injury to
the user or patient.

iii

Cautions

Caution

A Caution alerts you to where special care is necessary for the safe and
effective use of the product. Failure to observe a caution may result in minor
or moderate personal injury or damage to the product or other property, and
possibly in a remote risk of more serious injury.

Notes

A Note contains additional information on the product's usage.

iv

Contents

1. Introducing the IntelliVue MX40 1-1

MX40 Features -------------------------------------------------------------------------- 1-2
MX40 Models ---------------------------------------------------------------------------- 1-3
MX40 Compatibility -------------------------------------------------------------------- 1-4

2. Product Safety 2-1

General Safety -------------------------------------------------------------------------- 2-2
Safety Symbols & Other Marks ----------------------------------------------------- 2-4

3. Basic Operation 3-1

Controls, Indicators and Connectors ---------------------------------------------- 3-2

MX40 Controls and Indicators -------------------------------------------------- 3-2

Operating and Navigating ------------------------------------------------------------ 3-8

Power-On Self Test --------------------------------------------------------------- 3-8
Navigating --------------------------------------------------------------------------- 3-8
Selecting Display Elements ----------------------------------------------------- 3-9
Locking the Display---------------------------------------------------------------- 3-9
Measurement Area ---------------------------------------------------------------- 3-9
Measurement Area Display Configurations -------------------------------- 3-10
Connecting/Disconnecting the Patient Cable ----------------------------- 3-10

Understanding Settings -------------------------------------------------------------- 3-12

Changing Measurement Settings --------------------------------------------- 3-12
ECG Settings at the MX40 ----------------------------------------------------- 3-12
Waveform Settings at the MX40 ---------------------------------------------- 3-13

Battery Information -------------------------------------------------------------------- 3-14

Battery Safety Information ------------------------------------------------------ 3-14
Lithium-ion Rechargeable Battery Care ------------------------------------ 3-15
Inserting/Removing Batteries -------------------------------------------------- 3-16
Inserting Batteries ---------------------------------------------------------------- 3-17
Removing the Batteries --------------------------------------------------------- 3-19
Battery Charge Status ----------------------------------------------------------- 3-20

Pouch Use------------------------------------------------------------------------------- 3-22

Securing the Pouch -------------------------------------------------------------- 3-22
Showering -------------------------------------------------------------------------- 3-24

Telemetry Mode Use ----------------------------------------------------------------- 3-26
Monitoring Mode Use----------------------------------------------------------------- 3-27
Briefing the Patient -------------------------------------------------------------------- 3-28

4. Alarms 4-1

Alarms Overview ----------------------------------------------------------------------- 4-2

Visual Alarm Indicators ----------------------------------------------------------- 4-3
Audible Alarm Indicators when in Monitoring Mode ---------------------- 4-5
Acknowledging Alarms ----------------------------------------------------------- 4-6

Contents - 1

Pausing or Switching Off Alarms----------------------------------------------- 4-6
Alarm Limits ------------------------------------------------------------------------- 4-7
Reviewing Alarms ------------------------------------------------------------------ 4-8
Latching Alarms -------------------------------------------------------------------- 4-9
Alarm Latching Behavior --------------------------------------------------------- 4-9
Alarm Behavior at Power On ---------------------------------------------------- 4-9

Physiologic Alarms ------------------------------------------------------------------- 4-10
Technical Alarms (INOPs) --------------------------------------------------------- 4-14

5. ECG and Arrhythmia Monitoring 5-1

ECG Safety Information--------------------------------------------------------------- 5-2

For Paced Patients ---------------------------------------------------------------- 5-3

Measuring ECG ------------------------------------------------------------------------- 5-4
Connecting and Positioning ECG Electrodes ----------------------------------- 5-5
Selecting the Primary and Secondary ECG Leads ---------------------------- 5-6
Checking Paced Status --------------------------------------------------------------- 5-7
Understanding the ECG Display ---------------------------------------------------- 5-8
Monitoring Paced Patients ----------------------------------------------------------- 5-9

Avoiding Pace Pulse Repolarization Tails ----------------------------------- 5-9

Changing the Size of the ECG Wave ------------------------------------------- 5-10
Choosing EASI or Standard Lead Placement --------------------------------- 5-11
ECG Configuration ------------------------------------------------------------------- 5-12
ECG Leads Monitored --------------------------------------------------------------- 5-13
Reconstructed Leads ---------------------------------------------------------------- 5-15
3-Wire Placement -------------------------------------------------------------------- 5-16
5-Wire Placement (Standard Mode) --------------------------------------------- 5-17
5-Wire Placement (EASI Mode) -------------------------------------------------- 5-18
6-Wire Placement -------------------------------------------------------------------- 5-19

Selecting Positions of Va and Vb Chest Leads -------------------------- 5-19

Chest Electrode Placement -------------------------------------------------------- 5-20
Monitoring during Leads Off ------------------------------------------------------- 5-21

ECG Fallback --------------------------------------------------------------------- 5-21
Relearning ------------------------------------------------------------------------- 5-21

ST/AR Arrhythmia Monitoring ----------------------------------------------------- 5-23

ST/AR Arrhythmia Algorithm -------------------------------------------------- 5-23
How the ST/AR Algorithm Works -------------------------------------------- 5-23
ECG and Arrhythmia Alarm Overview -------------------------------------- 5-24
Using ECG Alarms --------------------------------------------------------------- 5-25
Learning ---------------------------------------------------------------------------- 5-27
Initiating Arrhythmia Relearning Manually --------------------------------- 5-29

ST/AR ST Analysis Algorithm ----------------------------------------------------- 5-30

Intended Use ---------------------------------------------------------------------- 5-30
The Measurement --------------------------------------------------------------- 5-31
Algorithm Processing ----------------------------------------------------------- 5-31
Displayed ST Data --------------------------------------------------------------- 5-32

Contents - 2

EASI ST Analysis ----------------------------------------------------------------- 5-32
Turning ST Monitoring On/Off ------------------------------------------------- 5-32

QT Interval Monitoring --------------------------------------------------------------- 5-33

Intended Use ----------------------------------------------------------------------- 5-34
How the QT Analysis Algorithm Works ------------------------------------- 5-34

6. Monitoring Pulse Rate 6-1

Pulse Rate Measurement ------------------------------------------------------------ 6-2
Displaying the Pulse Rate Measurement at the MX40 ----------------------- 6-3

7. SpO2 Monitoring 7-1

SpO2 Safety Information -------------------------------------------------------------- 7-2

SpO2 Information for the User -------------------------------------------------- 7-4

Pulse Oximetry Measurement ------------------------------------------------------ 7-5

SpO2 Sensors ----------------------------------------------------------------------- 7-6
Selecting an SpO2 Sensor ------------------------------------------------------- 7-6
Sensor Application Safety Information --------------------------------------- 7-7
Applying the Sensor --------------------------------------------------------------- 7-8
Connecting SpO2 Cables -------------------------------------------------------- 7-8
Tone Modulation Indication ----------------------------------------------------- 7-8
Signal Quality Indicator ----------------------------------------------------------- 7-8
Measuring SpO2 -------------------------------------------------------------------- 7-9
Understanding SpO2 Alarms --------------------------------------------------- 7-10

8. Monitoring with other Assigned Devices 8-1

Assigning Devices ---------------------------------------------------------------------- 8-3

Device Assignment at the Information Center ----------------------------- 8-3
Device Assignment at the MX40 ----------------------------------------------- 8-3
Device Assignment at the Patient Monitor ---------------------------------- 8-4

Controls Available when Assigned to IntelliVue Cableless Measurements8-6
Controls Available when Assigned to IntelliVue Patient Monitors --------- 8-7
Networked Device Synchronized Alarm Settings ------------------------------ 8-8
MX40 Display when Wirelessly Connected to a Patient Monitor ---------- 8-9

9. Monitoring with the MX40 at the Information Center 9-1

MX40 Connection to the Information Center ------------------------------------ 9-2
MX40 Controls in the Patient Window -------------------------------------------- 9-3
Locating the MX40 (Find Device) -------------------------------------------------- 9-5
Viewing Device Location and Location History (optional) ------------------- 9-6
Using the Device Location Client (optional) ------------------------------------- 9-7
Patient Configurable Settings in Telemetry Setup ----------------------------- 9-8
Unit Configurable Settings ---------------------------------------------------------- 9-11

10. Operating with Information Center Release L or M 10-1

Display ----------------------------------------------------------------------------------- 10-2
Alarms ------------------------------------------------------------------------------------ 10-3

Contents - 3

11. Trends (Optional) 11-1

Viewing Vital Trend Information -------------------------------------------------- 11-2

12. Maintenance 12-1

Cleaning --------------------------------------------------------------------------------- 12-2

Cleaning Materials for the MX40 --------------------------------------------- 12-2

Disposing of the MX40 -------------------------------------------------------------- 12-4
Label Assignment for Replacement MX40 ------------------------------------- 12-5

Re-assigning an Equipment Label ------------------------------------------ 12-5

Charging Lithium-ion Rechargeable Batteries -------------------------------- 12-7

Battery Power Indicators ------------------------------------------------------- 12-7
Battery Lifetime Management ------------------------------------------------ 12-8
Battery Disposal ------------------------------------------------------------------ 12-9

13. Safety Standards & Specifications 13-1

Regulatory Information -------------------------------------------------------------- 13-2

Software Hazard Prevention -------------------------------------------------- 13-2
AC Power Source ---------------------------------------------------------------- 13-2
Industrie Canada Compliance (Canada) ----------------------------------- 13-2
Safety Standards ----------------------------------------------------------------- 13-2
Intended Use Statement ------------------------------------------------------- 13-3
Indications for Use --------------------------------------------------------------- 13-3
Intended Uses of MX40 -------------------------------------------------------- 13-4
Authorized EU Representative ----------------------------------------------- 13-4
Patient Population --------------------------------------------------------------- 13-4
Rx ------------------------------------------------------------------------------------ 13-4
Essential Performance --------------------------------------------------------- 13-5

Electromagnetic Compatibility ----------------------------------------------------- 13-6

Reducing Electromagnetic Interference ------------------------------------ 13-7
Restrictions for Use-------------------------------------------------------------- 13-7
Electromagnetic Compatibility (EMC) Specifications ------------------- 13-7
Electromagnetic Emissions ---------------------------------------------------- 13-8
Electromagnetic Immunity ----------------------------------------------------- 13-8
Recommended Separation Distance --------------------------------------- 13-9

Battery Specifications -------------------------------------------------------------- 13-12
Lithium-ion Battery Charge Time ------------------------------------------------ 13-15
Physical Specifications ------------------------------------------------------------- 13-16
MX40 1.4 GHz Radio --------------------------------------------------------------- 13-17
MX40 2.4 GHz Radio --------------------------------------------------------------- 13-18
MX40 Short-Range Radio --------------------------------------------------------- 13-20
Environmental Specifications ----------------------------------------------------- 13-21
Measurement Specifications ----------------------------------------------------- 13-22

ECG -------------------------------------------------------------------------------- 13-22
ECG Performance Disclosure/Specifications ---------------------------- 13-23
FAST SpO2 ----------------------------------------------------------------------- 13-25
SpO2 Sensor Accuracy -------------------------------------------------------- 13-27

Contents - 4

A. Accessories A-1

MX40 Accessories --------------------------------------------------------------------- A-2

Pouches ------------------------------------------------------------------------------ A-2
Miscellaneous ----------------------------------------------------------------------- A-2

ECG Accessories ----------------------------------------------------------------------- A-3

Electrodes --------------------------------------------------------------------------- A-3
Leadsets and Patient Cables --------------------------------------------------- A-4

SpO2 Accessories ---------------------------------------------------------------------- A-5

Philips/Nellcor Disposable Sensors ------------------------------------------- A-5
Philips Reusable Sensors ------------------------------------------------------- A-6
Adapter Cables --------------------------------------------------------------------- A-6

B. Default Settings B-1

Alarm Default Settings ---------------------------------------------------------------- B-2
ECG, Arrhythmia, ST and QT Default Settings --------------------------------- B-3
Configuration Default Settings at the MX40 ------------------------------------- B-5

C. Sales and Support Offices C-1

Contents - 5

Contents - 6

MX40 Features ........................................................................................... 1-2

MX40 Models ............................................................................................. 1-3

MX40 Compatibility .................................................................................. 1-4

1. Introducing the IntelliVue
MX40

This section introduces the IntelliVue MX40 wearable patient monitor.

Introducing the IntelliVue MX40 1-1

MX40 Features

Easy for clinicians to use and comfortable for patients to wear.

2.8" color, touch sensitive display.
Smart, multi-measurement cable system available for use with reusable

and single-patient use supplies.

FAST SpO2 (continuous, or manual measurement).
EASI or standard ECG selectable in one device.
6-lead with two V-leads for diagnosing multiple cardiac abnormalities,

including wide-QRS complex tachycardias and acute myocardial
ischemia/infarction.

Local measurement trend/alarm history.
Local alarming for measurements (requires IntelliVue Information

Center Release N or later).

Integrated Smart-hopping radio.
Integrated Short-Range Radio (SRR).
Communication with IntelliVue Patient Monitors and Cableless

Measurements via Short-Range Radio connection (MP5/MP5T/MP5SC,
MP2 and X2 monitors only).

Powered by three AA batteries or rechargeable lithium-ion battery

pack.

Audio feedback for out-of-range and lost device.
Battery gauge on device and at Information Center.
Alarm suspend and resume from standby at device and Information

Center.

Pouch with clear front that closes securely.

Note — Unlike a traditional bedside monitor which operates on AC power,

the MX40 is powered by battery and provides time-limited screen display
and local alarming.

1-2 Introducing the IntelliVue MX40

MX40 Models

The MX40 is available in three models (ECG only, ECG and FAST SpO2, or
ECG and SpO2 Ready (for future upgrade).

Introducing the IntelliVue MX40 1-3

MX40 Compatibility

The MX40 is compatible for use with IntelliVue Information Center Release
N. Limited compatibility is offered when used with IntelliVue Information
Center Release L or M. See the "Operating with Release L or M" chapter for
more information.

The MX40 is compatible for use with IntelliVue Patient Monitors Release G
or later when wirelessly connected.

The MX40 is compatible for use with IntelliVue Cableless Measurements
Release A.1.

The MX40 is compatible for use with Access Point Controller 862147,
Release B.00.19 and Access Point Controller 865346, Release C.00.XX.

The MX40 Patient Cable is compatible for use with IntelliVue Patient
Monitor platforms MP2/X2, MP5/MP5T/MP5SC, MP20/30 with MMS or X2,
MP40/50 with MMS or X2, MP60/70 with MMS or X2, MP80/90 with MMS
or X2, and MX800/700/600 with MMS or X2.

1-4 Introducing the IntelliVue MX40

General Safety ............................................................................................ 2-2

Safety Symbols & Other Marks ............................................................... 2-4

2. Product Safety

This section consolidates the general safety warnings associated with the
IntelliVue MX40. These warnings are repeated throughout the book in
context where relevant.

Safety symbols and other markings on the MX40 are also described here.

Product Safety 2-1

General Safety

Warnings

The IntelliVue MX40 should not be used for primary monitoring in

applications where the momentary loss of the ECG is unacceptable at
the Information Center.

For continued safe use of this equipment, it is necessary that the listed

instructions are followed. Instructions in this manual in no way
supersede established medical procedures.

Do not touch the patient, or table, or instruments, during defibrillation.

The battery door must be closed during defibrillation. These steps
protect the clinician from high defibrillator voltage.

This device is not to be used in the vicinity of electrosurgical units

because such use may interrupt or interfere with the transmission of
signals from the MX40.

This equipment is not suitable for use in the presence of a flammable

anesthetic mixture with air, or with oxygen or nitrous oxide.

This equipment is not suitable for use in an MRI environment.
Do not use patient cables with detachable lead wires that have exposed

male pins. Electrocution could result if these pins are plugged into AC
power.

Do not use patient cables or accessory cables and sensors if prior visual

inspection reveals cable damage or the presence of liquid, lint or dust
inside.

The system is not completely immune from radio interference although

it is designed to minimize interference. Sources of interference that may
be a problem include failing fluorescent lights and construction
equipment. See "Electromagnetic Compatibility p. 13-6". The product
should not be used next to or stacked with other equipment. If you
must stack the product, you must check that normal operation is
possible in the necessary configuration before the product is used on
patients.

Do not rely exclusively on the audible alarm system for patient

monitoring. Adjustment of alarm volume to a low level during patient
monitoring may result in patient danger. Remember that the most
reliable method of patient monitoring combines close personal
surveillance with correct operation of monitoring equipment.

2-2 Product Safety

If the MX40 enters a continuous "boot-up" cycle or the main display

does not appear or update, ensure that you are using a freshly charged
lithium-ion battery or new disposable batteries. If the batteries are fresh
and the device reboots or does not update, remove the device from
service and contact your service personnel.

Place the MX40 in a pouch or over clothing, or both, during patient use.

The device should not touch the patient’s skin during use.

Patients should be instructed not to open the battery compartment

while the MX40 is in use.

Failure on the part of the responsible individual hospital or institution

employing the use of this equipment to implement satisfactory
maintenance as needed may cause undue equipment failure and
possible health hazards.

Because the coverage range of Access Points can sometimes overlap,

including different floor levels, the IntelliVue Device Location feature is
not intended for use when attempting to locate a patient.

Short-range radio connections are subject to interruption due to

interference from other radio sources in the vicinity, including
microwaves, bluetooth devices, and DECT phones. Outside the
frequency band and 5% above and below, i.e. the exclusion band
according to IEC 60601-1-2, the short-range radio connection is immune
up to 3V/m in the frequency range from 80MHz to 2.5 GHz. Depending
on the strength and duration of the interference, the interruption may
occur for an extended period. Any interruption of the signal due to
interference, moving out of range, or for other reasons is indicated with
a Tele Disconnected INOP message on the IntelliVue Patient Monitor.

Caution

Philips recommends that when using a pouch to attach the MX40 to your
patient that you consider your patient's condition and are careful about
placement of the straps as the straps could present a strangulation hazard.

Product Safety 2-3

Label

Definition

FCC ID:
IC:

Federal Communications
Commission (FCC) ID

Canadian ID

Federal Communications
Commission (FCC)
Grant of Equipment Authorization

CE Mark (MX40)

Compliance to Council
Directive 93/42/EEC (Medical
Device Directive)
Class 2 Radio Equipment
Identifier (1999/5/EC)

CE Mark (Rechargeable Lithium-ion
Battery)

Compliance to Council Directive
2004/108/EC (EMC Directive)

Non-Ionizing Radiation
Interference to electronic equipment

may occur in the vicinity of devices
marked with this symbol.

Disposal
Dispose of in accordance with the

local country’s requirements.

Follow operating instructions.

Safety Symbols & Other Marks

The table below describes the safety symbols and other markings present on the MX40 and the
lithium-ion battery.

2-4 Product Safety

Label

Definition

Prescription Device

Canadian and American standards
compliance

Complies with applicable Canadian
and American safety standards.

Defibrillation Proof
Patient connections are protected

against defibrillation
(DEFIBRILLATION-PROOF) and are a
TYPE CF APPLIED PART.

Product Number

Serial Number

Used to identify the equipment during
a call to the Philips Healthcare
(Service).

MAC Address

Date of Manufacture

Battery Polarity

IPX Waterproof Rating

2D Barcode
Underwriter's Laboratories Listed

Component

Service Identification Number

Used to identify the equipment during
a call to Philips Healthcare (Service).

Product Safety 2-5

Label

Definition

Attention! See Instructions for Use.

2-6 Product Safety

Controls, Indicators and Connectors ...................................................... 3-2

Operating and Navigating ....................................................................... 3-8

Understanding Settings .......................................................................... 3-12

Battery Information ................................................................................. 3-14

Pouch Use ................................................................................................. 3-22

Telemetry Mode Use ............................................................................... 3-26

Monitoring Mode Use ............................................................................. 3-27

Briefing the Patient .................................................................................. 3-28

3. Basic Operation

This section gives you an overview of the IntelliVue MX40 and its
functions. It tells you how to perform tasks that are common to all
measurements, such as turning a measurement on and off, adjusting wave
size and information in preparation for use.

Familiarize yourself with all instructions including warnings and cautions
before starting to monitor patients. Read and keep the Instructions for Use
that come with any accessories as these contain additional important
information.

Basic Operation 3-1

1. Patient Cable

2. Patient Information Area

3. Active Alarms Area

4. INOP Area

5. Measurement Area 1

6. Measurement Area 2

7. Waveform 1

8. Waveform 2

9. Radio/Network/Battery Status
Area

10. Leads Off Status Area

11. Silence Alarms Button

12. SmartKeys Button

13. Main Screen Button

14. Multi-Function Button

Controls, Indicators and Connectors

This section describes the clinical controls of the IntelliVue MX40. These
controls include buttons, display icons, visual and auditory indicators,
ports, and safety labeling located on the front and back of the device.

MX40 Controls and Indicators

3-2 Basic Operation

Button

Function

Depending on configuration at the Information
Center:

generates a Nurse Call;
Initiates a Delayed Recording;
Both, or;
None

Note — the Multi-Function Button does not operate

when paired with an IntelliVue Patient Monitor via
the short-range radio connection.

Button

Function

Initiates a local silence/acknowledgment of

all active alarms when enabled.

Silences the "Find Device" sound.

Note — Alarms at the MX40 can be silenced

from the Information Center.

Button

Function

Displays the SmartKey Menu on the touch
screen.

Multi-Function Button

Silence Alarm Button

SmartKeys Button

Basic Operation 3-3

Button

Function

Activates the Touch Display if touched for two

seconds.

Cycles through the display screens if touched

repeatedly.

Resumes from Standby.

SmartKey

Function

Start SpO2

Note — This

SmartKey is
unavailable
when SpO2
mode is
continuous.

Starts a manual SpO2 measurement.

Delay Record

Starts a delayed recording at the
Information Center.

Alarms

Review of up to 50 previous alarm
conditions (entries are stored during
power cycle). Pause Alarms for
configured time period (if enabled at
the Information Center).

Mode:
Telemetry /
Mode: Monitor

Toggles between modes. In
Telemetry Mode, display and audio
are off; in Monitor Mode, display and
audio are always on.

Main Screen Button

SmartKeys

The following table lists the SmartKeys available on the display of the
MX40.

Note—gray text on a SmartKey signifies that the item is unavailable.

3-4 Basic Operation

SmartKey

Function

Standby

Puts the device into standby locally
and at the Information Center.
Displays purchased/enabled product
options.

Add/Remove

Displays available monitors and
IntelliVue Cableless Measurements
to assign to via the short-range radio.

Print Reports

Prints the pre-configured report as
designated at the Information Center.

Vitals Trends
(Optional)

View up to 24 hours of tabular trend
data.

Screen Setup

Determines time period that the
display remains active after user
interaction.

Lock/Unlock

Locks/Unlocks the display.

Op Mode

Selects either Monitoring, Demo,
Config or Service modes.

The Alarm Area of the MX40 displays

physiological alarms and technical alarms.

A multiple alarm indicator (down arrow) is

displayed when multiple alarm conditions
are present.

A check mark in front of the alarm text

signifies that the alarm has been
acknowledged by touching the Silence
Alarms button.

Alarm Indicators display in the Patient

Information Area in place of the time clock
when alarm/INOP conditions are present
but have not been acknowledged.

Touching the Alarms Area displays a list of

all active alarms.

The alarms paused icon communicates

whether the alarm system is on/off.

Local Alarm Audio is off when the alarm

volume symbol is present.

Alarms Area

Basic Operation 3-5

The Patient Information Area displays the following information:

Bed Label
Patient Name (up to 15 characters will display)
Time

Touching the Patient Information Area displays the Patient Demogr. menu which lists
the following:

Patient Name (Last, First, Middle)
Lifetime ID
Encounter ID
Patient Category
Paced Mode
Height
Weight
Date of Birth
Gender

Note — If you use an alternative ID, it will display at the Information Center and on

printed reports. It will not display at the MX40.

1. Pacing algorithm is on.

2. Pacing algorithm is off.

Patient Information Area

Paced Status

3-6 Basic Operation

The Lock symbol appears in the lower left of the display when
the MX40 is in a locked state after five minutes of non-use.
Locking the display provides additional protection against
accidental patient access. The display is unlocked using the
SmartKeys menu.

The status area of the MX40 displays short-range radio
connection (optional) and system wireless connection
status. You can also view battery strength for the type
of battery used in the device, AA or rechargeable
Li-on.

Display Lock

Status Area

Basic Operation 3-7

Operating and Navigating

The principle method of operating your MX40 is via the Touch Display.
Almost every element on the display is interactive. Display elements
include measurement numerics, information fields, alarm fields,
waveforms, SmartKeys and menus.

Power-On Self Test

Once battery power is supplied, the MX40 performs a power-on self test to
check operational status prior to start-up. Should a failure be detected, an
INOP tone will sound and if possible, the appropriate INOP message for
the failure will be communicated to the Information Center and displayed
locally.

A successful power-on self test will then transition the MX40 to the start-up
screen. Selectable background colors can be configured and display on the
screen for assistance with device identification. This can be helpful when
devices are in a pooled use setting.

If the MX40 enters a continuous "boot-up" cycle or the main display does
not appear or update, ensure that you are using a freshly charged
lithium-ion battery or new disposable batteries. If the batteries are fresh and
the device reboots or does not update, remove the device from service and
contact your service personnel.

You must visually check that a waveform is present on the display. You can
access further status information is by touching the status area on the
display.

Navigating

Touching the Navigation Bar on the right of the display will scroll through
additional display items. Solid downward arrows indicate there are
additional elements that are not currently displayed. The arrows briefly
illuminate when touched. Your selection from the menu also illuminates
when touched.

3-8 Basic Operation

Function

Display
Locked/Active

Display
Locked/Inactive

Display
Unlocked/Active

Display
Unlocked/Inactive

Display Touch

No

No

Yes

No

Main Screen
Button

No

Yes

Yes

Yes
SmartKeys Button

Yes

No

Yes

No

Silence Button

No

No

Yes

No

Selecting Display Elements

Touch a display element to get to the actions linked to that element. For
example, touch the Patient Information element to call up the Patient Info
window, or touch the HR numeric to call up the Setup ECG menu. Touch
the ECG waveform to call up the wave selection menu.

Locking the Display

To provide additional protection against accidental patient access to the

MX40, the display can be locked using the Lock SmartKey. When Lock is
selected, the SmartKey menu automatically changes to the Main Screen.
When Unlock is selected, you must close the SmartKey menu to return to
the Main Screen.

The display automatically locks when there is no interaction for five
minutes.

Measurement Area

The measurement area of the MX40 display is optimized to show available
parameter numerics, waveforms, and alarm limits. Each element is a touch
object and when you select it, further controls and menus become available.

Basic Operation 3-9

Measurement Area Display Configurations

The display of your MX40 is configured/can operate in one of four available
orientations:

Portrait - One Waveform and four Numerics
Portrait - Two Waveforms and two Numerics (IIC Release N only)
Landscape - Two Waveforms and three Numerics (IIC Release N only)
Portrait - Viewable Chest Diagram and two Numerics

Connecting/Disconnecting the Patient Cable

The patient cable is connected to the MX40 as shown in the illustration
below.

When connecting to the MX40, there is a slight clicking sound that signifies
that the cable is securely connected.

3-10 Basic Operation

Disconnect the patient cable as shown below.

Caution

Never disconnect the patient cable by pulling on the leadwires, as this may
damage wires over time.

Basic Operation 3-11

Setting

Description

Alarm Limits

Heart Rate alarm limits can be viewed locally
at the MX40. Limits set at the Information
Center (Release N or later) are reflected at
the MX40 when connected on the network.

Primary
(used for arrhythmia analysis only)

I,II, III, aVR, aVL, aVF, V1-V9, MCL, V3R,
V4R, V5R. Available waveforms are based
on lead set type. Lead II is the default.

Secondary
(used for arrhythmia analysis only)

I,II, III, aVR, aVL, aVF, V1-V9, MCL, V3R,
V4R, V5R. Available waveforms are based
on lead set type. Lead V is the default.

Paced Mode

Yes, No

Adjust Size

Set ECG gain to x1/2, x1, x2, x4

Arrhythmia

Initiate an Arrhythmia Relearn; View
Arrhythmia Alarm Limits; Turn Arrhythmia
Annotation On/Off.

Lead Placement

Set EASI, Standard

Understanding Settings

Each aspect of how the MX40 works and looks is defined by a setting. There
are a number of different categories of settings, including:

Screen Settings - to define the selection and appearance of elements on

each individual display screen.

Measurement Settings - to define setting unique to each measurement,

e.g. high and low alarm limits.

Monitor Settings -including settings that affect more than one

measurement or display screen, for example alarm volume and alarm
pause time.

You must be aware that, although many settings can be changed during
use, permanent changes to settings can only be done in Configuration
Mode. All settings are restored to their default setting when the patient is
discharged or the MX40 is powered off.

Changing Measurement Settings

Each measurement has a setup menu in which you can adjust its settings.
You enter the setup menu by selecting the measurement numeric.

ECG Settings at the MX40

3-12 Basic Operation

Setting

Description

ECG

Set ECG On/Off

New Lead Setup

When IntelliVue Patient Monitor lead sets are
in use, select 3-wire, or 5-wire.

Va Lead

Shows position of Va, or C1, electrodes.
Choices are V1-V9, v3R, V4R, V5R.

Vb Lead

Shows position of Vb,or C2, electrodes.
Choices are V1-V9, v3R, V4R, V5R.

Change Numeric

Selects parameter numeric to display in
place of current HR numeric.

Setting

Description

Wave 1

Primary, Secondary, I, II, III, aVR, aVL, aVF,
V1-V9, MCL, V3R, V4R, V5R. Available
waveforms are based on patient cable type.
Lead II is the default. If Primary or Secondary
are selected, then the waveform displayed is
the waveform configured as primary or
secondary for arrhythmia analysis.

Wave 2

Primary, Secondary, I,II, III, aVR, aVL, aVF,
V1-V9, MCL, V3R, V4R, V5R, Pleth (if SpO2
is available). Available waveforms are based
on patient cable type. Lead V is the default.If
Primary or Secondary are selected, then the
waveform displayed is the waveform
configured as primary or secondary for
arrhythmia analysis.

Waveform Settings at the MX40

Primary or secondary waveform configuration changes made at the
Information Center change the MX40.

Basic Operation 3-13

Battery Information

Battery Safety Information

Warnings

The battery compartment door must be closed during defibrillation.
Use the Philips Rechargeable Lithium-ion Battery or 3 Duracell Alkaline

batteries, size AA, MN 1500, 1.5V, to ensure specified performance and
correct battery gauge reporting. Outdated, mismatched, or poor-quality
batteries can give unacceptable performance (e.g., insufficient
Battery-Low warning time). If you are using disposable batteries, the
use of fresh high-quality alkaline batteries is strongly recommended.

Certain failure conditions, such as short circuits, can cause a battery to

overheat during use. High temperatures can cause burns to the patient
and/or user. If the MX40 becomes hot to the touch, remove it from the
patient and place it aside until it cools. Then remove the batteries and
discard them. Have the MX40 checked by your service provider to
identify the cause of overheating.

If you receive a TELE BATTERY LOW, TELE BATTERY EMPTY,

REPLACE BATTERY T, or TELE BATTERY TEMP alarm, the batteries
must be promptly replaced. If these conditions are not corrected, they
will result in a device shutdown and cessation of monitoring.

Disposable batteries should be removed from the MX40 at the end of

the battery’s useful life to prevent leakage.

If battery leakage should occur, use caution in removing the battery.
The leaked substance may cause eye or skin irritation. Avoid contact
with skin. Clean the battery compartment according to the instructions
in the Maintenance section. Wash hands.

To eliminate the risk of electrical shock or burn, do not carry loose

batteries on your person, e.g. in clothing pockets.

Caution

Use of AA Lithium batteries or batteries with terminal voltage >1.6V may
cause damage to the device.

3-14 Basic Operation

Activity

When to Perform

Perform a visual inspection.

Before inserting a battery in the
MX40.

Charge the battery.

Upon receipt, after use, or if a low
battery state is indicated. To optimize
performance, a fully (or almost fully)
discharged battery should be charged
as soon as possible.

Clean the battery

At each patient discharge, or in cases
when the battery is exposed to
contaminants.

Charge stored batteries to at least
40% of their capacity every six
months.

When not in use for an extended
period of time.

Decommission the battery

When any of the following INOPs are
displayed on the MX40:

TELE SERVICE BATTERY
TELE BATTERY TEMP

Lithium-ion Rechargeable Battery Care

Care of the rechargeable battery begins when you receive a new battery for
use and continues throughout the life of the battery. The table below lists
battery care activities and when they should be performed.

Rechargeable batteries are charged using the IntelliVue CL Charging
Station. For information on charging station use, see Charging Li-ion
Rechargeable Batteries p. 12-7 .

Note — The battery capacity of re-chargeable batteries degrades over time

and number of recharge cycles. Toward the end of its useful life, the battery
capacity may be reduced by 25-30%. If this reduced battery life is
unacceptable based on your use model, Philips recommends replacing the
rechargeable battery sooner.

Lithium-ion Rechargeable Battery Handling Precautions

Lithium-ion batteries store a large amount of energy in a small package.
Use caution when handling the batteries; misuse or abuse could cause
bodily injury and/or equipment damage.

Do not short circuit - take care that the terminals do not contact metal

(e.g. coins) or other conductive materials during transport and storage.

Do not crush, drop or puncture - mechanical abuse can lead to internal

damage and internal short circuits that may not be visible externally.

Basic Operation 3-15

Do not apply reverse polarity.
Do not incinerate batteries or expose them to temperatures above 60

o

C

(140oF).

If a battery has been dropped or banged against a hard surface, whether
damage is visible externally or not:

discontinue use.
dispose of the battery in accordance with the disposal instructions.

Lithium-ion Rechargeable Battery Storage

When storing rechargeable batteries, make sure that the battery terminals
do not come into contact with metallic objects or other conductive
materials.

If batteries are stored for an extended period of time, they should be stored
in a cool, dry place, ideally at 15oC (60oF), with a state of charge of 20% to
40%. Storing batteries in a cool place slows the aging process.

The batteries should not be stored at a temperature outside the range of

-20oC (-4oF) to 50oC (122oF).

Stored batteries should be should be charged to at least 40% of their
capacity every 6 months.". They should be charged to full capacity prior to
use.

Note — Storing batteries at temperatures above 38

periods of time could significantly reduce the batteries' life expectancy.

Inserting/Removing Batteries

Warning

Arrhythmia relearning is initiated whenever the MX40 is powered down

for one minute or longer. Be sure to check your patient’s arrhythmia

annotation for accuracy whenever relearn has occurred.

Caution

o

C (100oF) for extended

Remove the batteries before storing the MX40 for an extended period of
time.

3-16 Basic Operation

The battery compartment is located on the back of the MX40, accessible by
opening the compartment door from the bottom. It accommodates three
AA 1.5V Alkaline batteries or the Philips Rechargeable Lithium-ion battery.
Only these batteries should be used.

Note— Lithium-ion batteries should be fully charged prior to first use.
Important— Do not use other rechargeable batteries. Use of this type of

battery will adversely affect:

Battery gauge performance
Battery low warnings
Battery life performance

Inserting Batteries

 Insert the rechargeable lithium-ion battery using the

following procedure:

Open the battery compartment by lifting up on both bottom sides of the
compartment door.

1 Remove the AA battery tray if present.
2 Insert the battery pack so that the raised tab is aligned with the cutout

in the base of the battery compartment. Close the battery compartment
door.

Basic Operation 3-17

3 Close the battery compartment door.
4 Watch for the start-up screen on the front of the MX40 to illuminate

briefly.

 Insert AA batteries into the MX40 using the following

procedure:

1 Open the battery compartment by lifting up on both bottom sides of the

compartment door.

2 Insert the AA battery tray if not already present.
3 Insert three AA 1.5V Alkaline batteries, matching the polarity with the

+indications inside the compartment.

Note—all batteries are inserted with the + polarity in the same direction.

3-18 Basic Operation

4 Close the battery compartment door.
5 Watch for the start-up screen on the front of the MX40 to illuminate

briefly.

Removing the Batteries

Batteries should be removed when the MX40 is not in use or is being stored.

To remove the batteries, open the battery compartment door and push from
the opening at the bottom of the compartment to pop the batteries out.
Device settings (patient cable type, SpO2 mode, volume, etc.) are retained
when the batteries are removed.

If you remove good AA batteries to turn off the MX40, keep them together
as a set for later re-use so that all batteries will have the same level of power
remaining.

Important— Do not "store" disposable AA batteries by leaving them in the

incorrect polarity position in the MX40.

Be careful not to short circuit the batteries. Batteries can get hot when
shorted. Short circuits are caused when a piece of metal touches both the
positive and negative terminals simultaneously. More than a momentary
short circuit will generally reduce the battery life. In case of a short circuit,
discard the batteries, or just the shorted one if the batteries are new.

Disposal of Batteries

When disposing of batteries, follow local laws for proper disposal. Dispose
of batteries in approved containers. If local regulations require you to
recycle batteries, recycle batteries in accordance with those regulations.

Basic Operation 3-19

Approximate
Battery Life
Remaining

Approximate
Time
Remaining
(ECG only)

Approximate
Time
Remaining
(ECG & Spo2
Continuous)

Functionality
Disabled

Battery
Indicator
LCD
Segments

100%

~ 25 hours

~ 14 hours

None

5 Green

75%

< 19 hours

< 10.5 hours

None

4 Green

50%

< 13 hours

< 7 hours

None

3 Green

25%

< 6 hours

< 3.5 hours

None

2 Green

10%

< 3 hours

< 1.5 hours

None

1 Green

Low battery
level to
replace/charge
battery level

< 30 minutes

< 30 minutes

SpO2 and
short-range
radio are
disabled.
Display is at
half
brightness

1 Red
Red Battery
Icon
Audio
Replace/charge
battery level

< 10 minutes

< 10 minutes

Device
shutdown

1 Red
Red Battery
Icon

Battery Charge Status

The battery charge indicator displays in the Status Area and communicates
the remaining battery charge time when using both AA batteries or the
rechargeable lithium-ion battery.

When the MX40 is initially powered-on, it takes approximately 25 seconds
for the indicator to populate. During this time, the indicator displays a ? in
the battery icon.

In order to guarantee overall device performance, certain functionality is
disabled when the battery charge reaches critical levels. See the tables
below for additional information about battery status.

Lithium-ion Rechargeable Battery Charge Status

3-20 Basic Operation

Approximate
Battery Life
Remaining

Approximate
Time
Remaining
(ECG only)

Approximate
Time
Remaining
(ECG & Spo2
Continuous)

Functionality
Disabled

Battery
Indicator LCD
Segments

100%

~ 24 hours

~ 9 hours

None

5 Green

75%

< 18 hours

< 7 hours

None

4 Green

50%

< 12 hours

< 5 hours

None

3 Green

25%

< 6 hours

< 2 hours

None

2 Green

10%

< 2 hours

< 1 hours

None

1 Green

Low battery
level to
replace/charge
battery level

< 30 minutes

< 30 minutes

SpO2 and
short-range
radio are
disabled.
Display is at
half
brightness.

1 Red
Red Battery
Icon
Audio
Replace/charge
battery level

< 10 minutes

< 10 minutes

Device
shutdown

1 Red
Red Battery
Icon

AA Battery Charge Status

Basic Operation 3-21

Pouch Use

The MX40 is not intended for direct contact with the patient’s skin. During
normal use, the MX40 should be worn over clothing, in a pocket or,
preferably, in a pouch. The Waterproof Carry Pouch with clear front is an
appropriate means for holding the MX40. See Appendix A, "Accessories"
for ordering information.

Securing the Pouch

1 See the Carry Pouch, Waterproof, Instructions for Use, P/N 453564267571,

for more information.

2 Insert the MX40 into the pouch with lead wires and SpO2 sensor cable, if

used, exiting from the side opening of the pouch. Pinch the velcro
enclosures together to close the pouch around the cables.

3-22 Basic Operation

3 Seal the pouch.

4 Secure the pouch on the patient with the ties around the patient’s

shoulder and under the arm.

5 Check that the patient is comfortable wearing the pouch with the MX40.

Caution

Philips recommends that when using a pouch to attach the MX40 to your
patient, consider your patient's condition and be careful about placement of
the straps, as the straps could present a strangulation hazard.

Basic Operation 3-23

Showering

Warning

When the patient is showering, signal quality and leads off detection may
be compromised due to significant movement. Appropriate clinical
precautions must be taken.

Caution

Because the touchscreen display is sensitive to water impact, the display
should be locked when showering.

The MX40 can be used to monitor a patient in the shower, but only when
placed inside a Philips carrying pouch and secured on the patient as
described above. The combination of the MX40 and pouch will withstand
showering for up to 10 minutes.

Drying the MX40 after Showering

After showering, perform the following steps to continue monitoring:

1 Remove the battery.
2 Pat dry the patient cable connections at the electrodes.
3 Wipe the lead wires with care.
4 If wet, dry the outside of the MX40 with a non-lint producing cloth.
5 If wet, wipe dry the inside of the battery compartment. Dry the

batteries.

6 If wet, disconnect the patient cable and shake out any water. Dry the

connector pin area with a cotton swab.

7 Re-insert the battery.

Caution

The MX40 should not be used for monitoring if the battery compartment is
wet. Remove the batteries and wipe the compartment dry before continued
monitoring use.

3-24 Basic Operation

Accidental Liquid Exposure

If the MX40 is accidentally immersed in liquid, no damage to the device
and no electrical safety issues for the patient will result. Remove the device,
dry it off, and follow the procedure for cleaning/sterilization under
"Cleaning and Sterilization" as needed.

Basic Operation 3-25

Telemetry Mode Use

To minimize patient disruption, the MX40 operates in Telemetry Mode
when connected to the Information Center. In Telemetry Mode, the local
volume is set to zero and the display is off. You can activate the display at
any time by touching the Main Screen button for two seconds. All active
alarms can be viewed when the display is on, however audible alarm
indicators are not annunciated. Regardless of the display status, all
measurement data is being sent to the Information Center. Telemetry Mode
is only available when connected to the Information Center.

3-26 Basic Operation

Monitoring Mode Use

You may find the use of Monitoring Mode helpful when spending extended
time directly with your patient, e.g. during transport, showering, dressing
change. The display is always on for easy viewing and should an alarm
condition occur, it will be announced locally at the MX40 and at the
Information Center if networked connected. If the MX40 is not network
connected, the alarm is only announced locally.

 To use Monitor Mode:

1 Press the SmartKeys Button.
2 Press the Mode: Telemetry / Mode: Monitor SmartKey and choose

Mode: Monitor.

Basic Operation 3-27

Briefing the Patient

Warning

Patients should be instructed not to interact with the with display of the
device and to not open the battery compartment while the MX40 is in use.

Note — Pausing alarms at the Information Center activates the MX40

display. Patients should be notified that this is normal operation and not
cause for any concern.

If the Multi-Function button has been configured to generate a Nurse Call
alarm, recording at the Information Center, or both, instruct the patient to
use the button when needed.

If desired, you can turn off patient use of the Multi-Function button at the
Information Center. For more information see Patient Configurable
Settings in Telemetry Setup p. 9-8.

3-28 Basic Operation

Basic Operation 3-29

Alarms Overview ...................................................................................... 4-2

Physiologic Alarms ................................................................................. 4-10

Technical Alarms (INOPs) ..................................................................... 4-14

4. Alarms

The section provides alarm information that applies to all measurements.
Measurement-specific alarm information is discussed in the sections on
individual measurements.

Alarms 4-1

Alarms Overview

The MX40 has two different types of alarms: physiological alarms and
INOPs. For MX40 devices operating with IntelliVue Information Center
Release L and M, physiological alarms are not available locally on the
MX40. INOPs are displayed as described here.

For MX40 devices operating with IntelliVue Information Center Release N,
physiological alarms are available locally on the MX40 regardless of
network connection to the Information Center. Alarm settings are as
configured by the Information Center. Changes to physiological alarm
settings can only be made at the Information Center. Audible alarm
indicators are annunciated only when operating in Monitor Mode or when
the MX40 is not networked connected.

Physiological Alarms

Physiological alarms are red and yellow alarms. A red alarm indicates a
high priority patient alarm such as a potentially life threatening situation
(for example, asystole). A yellow alarm indicates a lower priority patient
alarm (for example, a low SpO2 alarm limit violation). Additionally there
are short yellow alarms, most of which are specific to arrhythmia-related
patient conditions (for example, ventricular bigeminy).

INOPs

INOPs are technical alarms, they indicate that the monitor cannot measure
or detect alarm conditions reliably. If an INOP interrupts monitoring and
alarm detection (for example, LEADS OFF), the monitor places a question
mark in place of the measurement numeric and an audible indicator tone
will be sounded. INOPs without this audible indicator indicate that there
may be a problem with the reliability of the data, but that monitoring is not
interrupted.

Most INOPs are light blue, however there are a small number of INOPs
which are always yellow or red to indicate a severity corresponding to red
and yellow alarms. The following INOPs can also be configured as red or
yellow INOPs to provide a severity indication:

ECG LEADS OFF
REPLACE BATTERY (when using disposable batteries)
TELE BATT EMPTY (when using the rechargeable battery pack)

All monitors in a unit should have the same severity configured for these
INOPs.

4-2 Alarms

The MX40 is designed to achieve visual alarm notification at a distance of
up to one meter, which is consistent with its intended use model as a
wearable monitor.

Alarms are indicated after the alarm delay time. This is made up of the
system delay time plus the trigger delay time for the individual
measurement. For more information see ECG Performance
Disclosure/Specifications p. 13-23 .

If more than one alarm is active, the highest priority alarm is shown. A
downward facing arrow symbol next to the alarm message informs you
that more than one message is active. The monitor sounds an audible
indicator for the highest priority alarm.

Visual Alarm Indicators

Warning

The MX40 display is inactive for a majority of the time because it is
operating in Telemetry Mode. You must activate the screen to view any
alarms locally. The alarm message text is displayed, however, the alarm
volume setting is at zero.

Alarm Message

An alarm message text appears in the alarm status area at the top of the
screen indicating the source of the alarm. If more than one alarm is present,
there is a downward facing arrow symbol at the right side. The background
color of the alarm message matches the alarm priority: red for red alarms,
yellow for yellow alarms, light blue for standard INOPs, red for red INOPs
and yellow for yellow INOPs. The asterisk symbols (*) beside the alarm
message match the alarm priority: *** for red alarms, ** for yellow alarms, *
for short yellow alarms. Standard INOPs do not have a symbol, red and
yellow INOPs have exclamation marks beside the alarm message: !!! for red
INOPs and !! for yellow INOPs.

Alarm limit violation messages are displayed in text form, for example **
SpO2 LOW.

Alarms 4-3

INOP Color

On

Off

Yellow

1.0 seconds

1.0 seconds

Red

0.25 seconds

0.25 seconds

Alarm Indicator

An Alarm Indicator on the MX40 main display communicates alarm/INOP
conditions that have not been acknowledged. The alarm indicator is
divided into two sections and appears in the upper right hand corner
normally occupied by the time display. The right section flashes for a
physiological alarm, except for short yellow alarms where the indicator will
light for approximately six seconds. The color is yellow or red
corresponding to the highest priority alarm currently present.

An unacknowledged physiological alarm and INOP appears as (portrait
view):

An acknowledged physiological alarm and INOP with an additional
unacknowledged physiological alarm appears as (landscape view):

The left section lights continuously for a standard INOP and flashes for
INOPs configured as red or yellow alarms as follows:

If only patient alarms are present, and no INOPs, the patient alarms will
use both left and right sections to flash (for red and yellow alarms) or light
for approximately six seconds (for short yellow alarms). If only INOPs are
present, and no patient alarms, red and yellow INOPs will use both left and
right sections to flash, but standard INOPs will always light continuously in
the left section only.

Once all alarm/INOP conditions are acknowledged, the time display
reappears.

Flashing Numeric

4-4 Alarms

The numeric of the measurement in alarm flashes.

Audible Alarm Indicators when in Monitoring Mode

The audible alarm indicators configured for your monitor depend on which
alarm standard applies in your hospital. Audible alarm indicator patterns
are repeated until you acknowledge the alarm by switching it off or
pausing it, or until the alarm condition ceases (if audible alarm indication is
set to non-latching).

Warning

Do not rely exclusively on the audible alarm system for patient

monitoring. Adjustment of alarm volume to a low level or off during
patient monitoring may result in patient danger. Remember that the
most reliable method of patient monitoring combines close personal
surveillance with correct operation of monitoring equipment.

No audible alarm indicators are available when the MX40's volume

setting is zero or when operating in Telemetry Mode. Audible alarm
indicators become active as soon as the MX40 is no longer connected to
the Information Center.

Traditional Audible Alarms (HP/Agilent/Philips/Carenet)

Red alarms and red INOPs: A high pitched sound is repeated once a

second.

Two-star yellow alarms and yellow INOPs: A lower pitched sound is

repeated every two seconds.

One-star yellow alarms (short yellow alarms): The audible indicator is

the same as for yellow alarms, but of shorter duration.

Standard INOPs: an INOP tone is repeated every two seconds.

ISO/IEC Standard Audible Alarms

Red alarms and red INOPs: A high pitched tone is repeated five times,

followed by a pause.

Two-star yellow alarms and yellow INOPs: A lower pitched tone is

repeated three times, followed by a pause.

One-star yellow alarms (short yellow alarms): The audible indicator is

the same as for yellow alarms, but of shorter duration.

Standard INOPs: a lower pitched tone is repeated twice, followed by a

pause.

Alarms 4-5

Acknowledging Alarms

To acknowledge all active alarms and INOPs, touch the Silence Alarm
button. This switches off the audible alarm indicators, if present, and alarm
messages.

A check mark beside the alarm message indicates that the alarm has been
acknowledged.

If the condition that triggered the alarm is still present after the alarm has
been acknowledged, the alarm message stays on the screen with a check
mark symbol beside it, except for NBP alarms and alarms from other
intermittent measurements. When such an alarm is acknowledged the
alarm message disappears.

If the alarm condition is no longer present, all alarm indicators stop and the
alarm is reset.

Switching off the alarms for the measurement in alarm, or switching off the
measurement itself, also stops alarm indication.

Pausing or Switching Off Alarms

If you want to temporarily prevent alarms from sounding, for example
while you are moving a patient, you can pause alarms, if configured.
Depending on your MX40 configuration, alarms are paused for one, two or
three minutes.

Cautions

When operating with Information Center Release L or M, the alarm

pause time of the MX40 is not configurable. The alarm pause time for
the MX40 is always two minutes.

When operating with Information Center Release L or M, if alarms are

paused at the Information Center, the "Alarms Paused" message is only
displayed at the Information Center.

To Pause All Alarms

4-6 Alarms

Select the Alarms SmartKey and select Pause Alarms. A timer on the

display shows the remaining pause time.

To Switch Individual Measurement Alarms On or Off

1 Select the measurement numeric to enter its setup menu.
2 Select Alarms to switch between on and off

The alarms off symbol is shown beside the measurement numeric.

While Alarms are Paused

In the alarm field, the MX40 displays the message ALARMS PAUSED

1:28 or ALARMS OFF, together with the alarms paused symbol or the
alarms off symbol.

No alarms are sounded and no alarm messages are shown.
INOP messages are shown but no INOP tones are sounded.

The only exceptions are the INOPs CUFF NOT DEFLATED, NBP CUFF
OVERPRESS and INOPs relating to empty, missing and malfunctioning
batteries.

These INOPs switch the alarms on, and the INOP tones are sounded,
even if alarms are paused or off. You need to remove the INOP
condition first before you can switch the alarm tones off again.

Warning

If connection to the Information Center is lost during an alarms paused
period, upon reconnection, alarms remain paused at the Information Center
for the set time. You can resume alarms from the Patient Window at the
Information Center at any time.

Restarting Paused Alarms

To manually switch on alarm indication again after a pause, select Pause
Alarms.

Alarm Limits

The alarm limits you set determine the conditions that trigger yellow and
red limit alarms. For some measurements (for example, SpO2), where the
value ranges from 100 to 0, setting the high alarm limit to 100 switches the
high alarm off, or setting the low alarm limit to 0 switches it off. In these
cases, the alarms off symbol is not displayed.

Alarms 4-7

Warning

Be aware that the monitors in your care area may each have different alarm
settings, to suit different patients. Always check that the alarm settings are
appropriate for your patient before you start monitoring.

Viewing Individual Alarm Limits

You can see the alarm limits set for each measurement next to the
measurement numeric on the main screen.

Reviewing Alarms

You can see which alarms and INOPs are currently active in the respective
alarms and INOPs fields at the top of the screen.

To see the currently active alarms and INOPs listed in one place, touch the
Alarms area.

All alarms and INOPs are erased from the Alarm Messages window when
you discharge a patient, or if you change to Demonstration Mode.

Review Alarms Window

The Review Alarms window contains a list of the 50 most recent alarms and
INOPs with date and time information.

The Review Alarms window also shows when alarms are paused or
silenced.

4-8 Alarms

Note — Alarms that occur during an alarm suspend period will appear in

the Review Alarm window, however, they are not communicated to the
Information Center.

Red & Yellow Measurement Alarms

Non-latching
Alarms

Visual and
Audible Latching

Alarm has not been
acknowledged.

Alarm condition still
present.

Alarm tone on. Alarm
message. Flashing
numerics.

Alarm tone on.
Alarm message.
Flashing numerics.

Alarm condition no
longer present.

All audible and visual
alarm indicators
automatically stop.

Alarm tone on.
Alarm message .
Flashing numerics.

Alarm has been
acknowledged.

Alarm condition still
present.

Alarm tone off. Alarm
message with check
mark. Flashing
numerics. Audible
alarm reminder (if
configured)

Alarm tone off.
Alarm message
with check mark.
Flashing numerics.
Audible alarm
reminder (if
configured)

Alarm condition no
longer present.

Audible and visual
alarm indicators
automatically stop.

Audible and visual
alarm indicators
automatically stop.

Latching Alarms

The alarm latching setting for your MX40 defines how the alarm indicators
behave when you do not acknowledge them. When alarms are set to
non-latching, their indicators end when the alarm condition ends.
Switching alarm latching on means that visual and/or audible alarm
indications are still displayed or announced by the monitor after the alarm
condition ends. The indication lasts until you acknowledge the alarm by
touching the Alarm Silence button.

Alarm Latching Behavior

Alarm Behavior at Power On

Alarms 4-9

If the MX40 is powered off for longer than one minute and then powered
on again (or after a loss of power lasting longer than one minute, or when a
patient is discharged), the device restores the alarm settings from the
Information Center's configured default settings.

If power is lost for less than one minute, the alarm on/off condition prior to
the power loss is restored.

Alarm Text

Priority

Condition

Source

*** ASYSTOLE

Red

Asystole.
No QRS for 4 consecutive seconds

ST/AR
Basic &
Enhanced
Arrhythmia

*** EXTREME BRADY

Red

Extreme Bradycardia.
Heart Rate (yyy) less than Extreme
Brady limit (xxx)

ST/AR
Basic &
Enhanced
Arrhythmia

Physiologic Alarms

Physiologic alarms indicate a life-threatening situation or a less urgent
situation such as heart rate beyond limits.

Warning

Do not rely exclusively on the audible alarm system for patient

monitoring. Adjustment of alarm volume to a low level during patient
monitoring may result in patient danger. Remember that the most
reliable method of patient monitoring combines close personal
surveillance with correct operation of monitoring equipment.

ST and QT related alarm messages appear at the Information Center

only.

Arrhythmia alarm chaining and customizing arrhythmia alarm settings are
described in the ECG and Arrhythmia Monitoring chapter. There are two
levels of arrhythmia analysis available: Basic and Enhanced. Enhanced
analysis includes Basic alarms.

The MX40 provides physiological alarms based on the settings at the
Information Center, Release N or later. Alarming is not active on the MX40
until it is configured via an active association with the Information Center.

In the following table, Red (***) alarms are listed alphabetically, followed by
the Yellow (**) alarms, and the Yellow (*) alarms.

Note — The physiological alarm messages displayed on the MX40 use a

short text format. Alarm messages displayed at the Information Center use
and extended text format, e.g. "*HR yyy<xxx".

4-10 Alarms

Alarm Text

Priority

Condition

Source

*** DESAT

Red

Very Low SpO2 Saturation.
SpO2 value below Desaturation limit

Note— Desat limit is set 10 points

below low limit.

SpO2
***EXTREME TACHY

Red

Extreme Tachycardia.
Heart Rate (yyy) greater than Extreme
Tachy limit

ST/AR
Basic &
Enhanced
Arrhythmia

*** VENT FIB/TACH

Red

Ventricular Fibrillation.
Fibrillatory wave (sinusoidal wave
between 2-10 Hz) for 4 consecutive
seconds

ST/AR
Basic &
Enhanced
Arrhythmia

*** V-TACH

Red

Ventricular Tachycardia.
Consecutive PVCs greater than or
equal to V-Tach Run limit and Heart
Rate greater than V-Tach limit (xxx)

ST/AR
Basic &
Enhanced
Arrhythmia

*/**AFIB

Yellow

Atrial fibrillation waveform detected

ST/AR
Enhanced
Arrhythmia

**NBP High

Yellow

High limit has been exceeded for high
pressure limit

NBP

**NBP Low

Yellow

Low limit has been exceeded for low
pressure limit

NBP

** SpO2T HIGH

Yellow

High SpO2.
SpO2 value (yyy) greater than high
SpO2 limit (xxx).

SpO2

** SpO2T LOW

Yellow

Low SpO2.
SpO2 value (yyy) less than low SpO2

limit (xxx).

SpO2

*/** HR High

Yellow

Heart Rate (yyy) greater than the
upper Heart rate limit (xxx).

ST/AR
Basic &
Enhanced

Arrhythmia

*/** HR Low

Yellow

Heart Rate (yyy) lower than the lower
Heart Rate limit (xxx).

ST/AR
Basic &
Enhanced

Arrhythmia

*/** IRREGULAR HR

Yellow

Consistently irregular rhythm (irregular
R-R intervals).

ST/AR
Enhanced

Arrhythmia

Alarms 4-11

Alarm Text

Priority

Condition

Source

* MISSED BEAT

Yellow

No beat detected for 1.75 x average
R-R interval for Heart Rate greater
than 120, or no beat for 1 second with
Heart Rate greater than 120
(non-paced patient only).

ST/AR
Enhanced

Arrhythmia

* MULTIFORM PVCs

Yellow

The occurrence of two differently
shaped Vs, each occurring at least
twice within the last 300 beats as well
as each occurring at least once within
the last 60 beats.

ST/AR
Enhanced

Arrhythmia

* NON-SUSTAIN VT

Yellow

A run of Vs having a ventricular Heart
Rate greater than V-Tach limit but
lasting for less than the V-Tach Run
limit.

ST/AR
Enhanced

Arrhythmia

*Nurse Call

Yellow

The patient has pressed the
Multi-Function Button on the MX40.

* PACER NOT CAPTURE

Yellow

No QRS for 1.75 x the average R-R
interval with Pace Pulse (paced
patient only).

ST/AR
Basic &
Enhanced

Arrhythmia

* PACER NOT PACING

Yellow

No QRS and Pace Pulse for 1.75 x
the average R-R interval (paced
patient only).

ST/AR
Basic &
Enhanced

Arrhythmia

* PAIR PVCs

Yellow

Two consecutive PVCs between
non-PVCs.

ST/AR
Enhanced

Arrhythmia

* PAUSE

Yellow

No QRS detected for x seconds.
Choices of >1.5 to 2.5 seconds.

ST/AR
Enhanced

Arrhythmia

* PVCs /MIN HIGH

Yellow

PVCs within one minute exceed by
the PVCs/min limit (xxx).

ST/AR
Basic &
Enhanced

Arrhythmia

4-12 Alarms

Alarm Text

Priority

Condition

Source

* R-ON-T PVCs

Yellow

For Heart Rate less than 100, a PVC
with R-R interval less than 1/3 the
average interval followed by a
compensatory pause of 1.25 x
average R-R interval, or 2 such Vs
without a compensatory pause
occurring within 5 minutes of each
other. (When Heart Rate is greater
than 100, 1/3 R-R interval is too short
for detection.)

ST/AR
Enhanced

Arrhythmia

* RUN PVCs

Yellow

Run of PVCs greater than or equal to

2.

ST/AR
Enhanced

Arrhythmia

* SVT

Yellow

Run of SVPBs greater than or equal
to SVT Run limit and with SVT Heart
Rate greater than the SVT Heart Rate
limit.

ST/AR
Enhanced
Arrhythmia

* VENT BIGEMINY

Yellow

A dominant rhythm of N, V, N, V
(where N= supraventricular beat,
V=ventricular beat).

ST/AR
Enhanced

Arrhythmia

* VENT RHYTHM

Yellow

A dominant rhythm of adjacent Vs
greater than Vent Rhythm limit and
ventricular Heart Rate less than
V-Tach limit.

ST/AR
Enhanced

Arrhythmia

* VENT TRIGEMINY

Yellow

A dominant rhythm of N, N, V, N, N, V
(where N=supraventricular beat,
V=ventricular beat).

ST/AR
Enhanced

Arrhythmia

Alarms 4-13

Alarm Text

Priority

Condition

What to do

BATTERY LOW T

Source - MX40

Soft

There is less than 15

minutes of monitoring
time remaining (AA
batteries).

Lithium-ion battery

level is < 10% or has
<30 minutes
remaining time.

Replace batteries

promptly to avoid
shutdown and cessation of
monitoring.

Insert a charged
lithium-ion battery pack.

CANNOT ANALYZE
ECG

Source - MX40 and
Information Center

Hard

Arrhythmia algorithm
cannot reliably analyze
the ECG data on any
monitored leads.

Assess the lead selections,
initiate relearn, and validate
analyzed rhythm. Check
other INOPs for possible
source of problem.

Technical Alarms (INOPs)

Technical Alarms, or INOPs (inoperative conditions), are sourced at the
MX40, the ST/AR algorithm running at the Information Center, or the
IntelliVue Patient Monitor. They identify inoperative conditions (that is
conditions where the system is not operating properly and therefore cannot
measure or detect alarm conditions reliably). There are four levels of
Technical Alarms:

Severe - Monitoring and alarm generation are disabled. Visual alarm

indicator on the MX40. Audible tone at the Information Center. Must be
acknowledged by a clinician.

Hard - Monitoring and alarm generation are disabled. Visual alarm

indicator on the MX40. Audible tone at the Information Center.
If the hard INOP is "latched", the sound will be silenced, but the
message will remain on the display until resolution of the offending
condition.

Soft - Monitoring and alarms remain active. Visual alarm indicator on

the MX40 and at the Information Center. No audible tones are
generated at the Information Center

Red/Yellow - Replace Battery and ECG Leads Off INOPs may be

configured to display as either Red or Yellow Technical Alarms.

Note - The ECG Leads Off INOP will initially display as a cyan

technical alarm until a valid ECG signal is obtained.

In the following table, technical alarms are listed alphabetically.

4-14 Alarms

Alarm Text

Priority

Condition

What to do

CHECK PAIRING

Source - MX40

Yellow
Technic
al Alarm

There is a problem

with device pairing.

When the MX40 is

wirelessly paired with
an X2 patient monitor
(no label) docked with
a larger networked MP
series monitor, and
the network
connection is lost.

Check that the bedside

monitor is correctly paired.

Select the correct device

to be paired.

cl NBP Batt Low

Source - Cableless
Measurement Device

Hard

CL NBP Pod weak
battery condition.

Charge CL NBP Pod.

cl NBP Batt Empty

Source - Cableless
Measurement Device

Severe

CL NBP Pod empty
battery condition.
Monitoring is not
possible.

Replace CL NBP Pod.
Recharge depleted CL

NBP Pod.

cl NBP DISCONNECT

Source - Cableless
Measurement Device

Hard

CL NBP Pod is not
connected with the
MX40.

Resolve interference

condition.

Reduce range between

CL NBP Pod and MX40.

cl SpO2 Batt Low

Source - Cableless
Measurement Device

Hard

CL SpO2 Pod weak
battery condition.

Charge CL SpO2 Pod.

cl SpO2 Batt Empty

Source - Cableless
Measurement Device

Severe

CL SpO2 Pod empty
battery condition.
Monitoring is not
possible.

Replace CL SpO2 Pod.
Recharge depleted SpO2

Pod.

cl SpO2 DISCONNECT

Source - Cableless
Measurement Device

Hard

CL SpO2 Pod is not
connected with the
MX40.

Resolve interference

condition.

Reduce range between

CL SpO2 Pod and MX40.

!!!/!! CUFF NOT
DEFLATED

Source - Cableless
Measurement Device

Severe

Cuff pressure has
exceeded the specified
safety limit.

Remove cuff and tubing and
expel air.

Alarms 4-15

Alarm Text

Priority

Condition

What to do

!!!/!! CUFF OVERPRESS

Source - Cableless
Measurement Device

Severe

Cuff pressure has
increased above
overpressure safety
limits.

Remove cuff and tubing and
expel air.

ECG/ARRH ALARM
OFF

Source - MX40

Soft

ECG is turned off.

Turn on ECG.

ECG LEADS OFF
Note This INOP may

also be configured to
display as a Red or
Yellow Technical Alarm.

Source - MX40

Red or
Yellow
or Hard
Technic
al Alarm

Multiple leads are off.

Re-attach ECG leads to
patient..

<electrode> LEAD OFF

Source - MX40

Hard

Single lead is off.
If primary lead is MCL,

lead will be identified as
V/C in INOP text.

Re-attach ECG leads to
patient.

LEADSET UNPLUGGED

Source - MX40

Hard

Patient cable has

been unplugged from
the MX40.

Incompatible leadset

attached to patient
cable.

Re-attach the patient

cable.

Replace the leadset.

LOCAL AUDIO OFF

Source - MX40

Note — This is normal

operation in Telemetry
Mode.

Soft

There is no alarm audio
notification when
operating in Telemetry
Mode.

Change to Monitor Mode.

NBP INTERRUPTED

Source - Cableless
Measurement Device

Hard

The preset maximum
time for the total
measurement has been
exceeded.

Reduce patient movement
and avoid interaction with the
cuff and tubing.

NBP MEASURE FAILED

Source - Cableless
Measurement Device

Hard

Measurement values
cannot be derived.

Attach cuff to new location

on patient.

Replace cuff.

4-16 Alarms

Alarm Text

Priority

Condition

What to do

NBP EQUIP MALF

Source - Cableless
Measurement Device

Hard

Tubing may be

obstructed or kinked.

Hardware malfunction.

Check tubing.
If condition persists,

contact Service.

NO ALARM DISPLAY

Source - MX40

Soft

When operating with
Information Center
Release L Or M, there is
no local alarming at the
MX40, networked or
non-networked.

Condition is not present when
operating with Information
Center Release N or later
(unless specifically
configured to operate in this
way).

NO CENTRAL
MONITOR
(appears at MX40 only)

Source - MX40

Hard

The MX40 is out of

range of the network.

Patient Sector at the

Information Center is
in Standby.

Return the MX40 to the

coverage area.

Select Resume at the

Information Center.

NO HOST
MONITORING

Source - MX40

Hard

The paired
MX40/bedside monitor is
out of short-range radio
range or there is
excessive radio
interference.

Reduce the distance

between the devices.

Identify and remove

interference source.

NO SIGNAL
(appears at the
Information Center only)

Source - Information
Center

Hard,
Latched

The MX40 is outside

the coverage area, or

No batteries in the

MX40, or

The MX40 has failed.

Make sure that the MX40

is within the coverage
area and has good
batteries.

Replace the MX40 if

Power On Self Test fails.
Put bed in Standby.
Contact Service

REPLACE BATTERY T

Source - MX40

Note — This INOP may

also be configured to
display as a Red or
Yellow Technical
Alarm.

Red or
Yellow
or Hard
Technic
al
Alarm,
Latched

Dead battery. No

monitoring is

occurring.
When operating

wirelessly, the patient

monitor is no longer

providing power to the

MX40, and battery

capacity is now

depleted.

Replace batteries.

Alarms 4-17

Alarm Text

Priority

Condition

What to do

SpO2T EQUIP MALF

Source - MX40

Hard

Malfunction in the SpO2
equipment

Contact Service.

SpO2T ERRATIC

Source - MX40

Hard

Erratic SpO2
measurements, often due
to a faulty sensor or
invalid SpO2
measurements, or
incorrect transducer
position

Repeat measurement,
reposition sensor on patient,
or finally, replace sensor.

SpO2T EXTD UPDATE
Numeric is replaced by a

-?-.

Source - MX40

Soft

The update period of
displayed values is
extended due to an NBP
measurement on the
same limb or an
excessively noisy signal.

If NBP is not active, check
the sensor placement.
Reposition the sensor on
patient, or replace sensor.

SpO2T LOW PERF

Source - Monitor

Soft

Accuracy may be
reduced due to low
perfusion. Data displayed
with ?.

Increase perfusion. Change
sensor site. Avoid site distal
to BP cuff or intra-arterial
line. Warm the site.

SpO2T INTERFERENCE

Source - MX40

Hard

Level of ambient light or
level of electrical
interference are so high
that the SpO2 sensor
cannot measure SpO2
and pulse rate.

Reduce ambient light to
sensor or electrical noise
sources.

SpO2T NO SENSOR

Note — Silencing this

technical alarm turns off
the SpO2 measurement
on the MX40 only (not at
the Information Center).

Source - MX40

Hard

No sensor attached to
SpO2 device.

Attach SpO2 sensor.

%SpO2T NOISY SIGN

Source - MX40

Hard

Excessive patient
movements or electrical
interference are causing
irregular pulse patterns

Reduce movement or
electrical noise sources.

4-18 Alarms

Alarm Text

Priority

Condition

What to do

SpO2T NO PULSE

Source - MX40

Note — When paired

directly with an IntelliVue
MP5 Patient Monitor, the
INOP will display as
SpO2T SENSOR OFF.

Hard

Pulse is too weak or

not detectable
Sensor has fallen off

at patient.

Check connection to

patient.
Change sensor site. Avoid

site distal to BP cuff or

intra-arterial line.

SpO2 POOR SIGNAL

Source - MX40

Soft

Although a measurement
may be possible, its
accuracy may be
reduced due to poor
signal quality.

Apply the sensor

according to the

manufacturer's

instructions.
Relocate the sensor to a

different site on the

patient.

SpO2T SEARCHING

Source - MX40

Soft

The patient signal is
analyzed, but a valid
numeric is not available
yet.

Wait for the measurement to
complete.

SpO2T SENSOR OFF

Note — The ability of

the algorithm to detect
this condition depends
on the sensor type in
use.

Hard

The algorithm has
determined that a sensor
is connected, but not
properly applied to the
patient.

Apply the sensor

according to the

manufacturer's

instructions.
If the condition persists,

relocate the sensor to a

different site on the

patient.

SpO2T SENSOR MALF

Source - MX40

Hard

Malfunction of the SpO2
sensor/adapter cable

Replace sensor.

SpO2 UNKN SENSOR

Source - MX40

Hard

The connected SpO2
sensor and/or adapter
cable is not supported by
the hardware version.

Use specified sensor and/or
adapter cable.

SpO2T UPGRADE
Source - MX40

Soft

SpO2 hardware is in
upgrade process.
Monitoring is not
possible.

Wait for the upgrade process
to complete.

TELE BATTERY LOW
Source - MX40

Soft

Lithium-ion battery level
is < 20% or has <30
remaining time.

Insert a charged lithium-ion
battery pack.

Alarms 4-19

Alarm Text

Priority

Condition

What to do

TELE BATT EMPTY

Note — This INOP may

also be configured to
display as a Red or
Yellow Technical Alarm.

Source - MX40

Note — For Information

Center Release L or M,
this INOP will appear as
"REPLACE BATTERY
T".

Hard,
Latched

Lithium-ion battery level
is critically low. A
10-minute countdown
begins. The MX40 will
shut down if the condition
is not cleared.

Insert a charged lithium-ion
battery pack.

TELE BATTERY TEMP
Source - MX40

Note — For Information

Center Release L or M,
this INOP will appear as
"REPLACE BATTERY T"

Hard

The temperature of the
lithium-ion battery is
above 55o C or below -5o
C.

Replace the lithium-ion
battery.

TELE CHECK BATT
Source - MX40

Soft

Lithium-ion battery has <
25 charge cycles
remaining before
reaching the charge
cycle maximum limit.

Be aware that the Lithium-ion
battery pack will soon need
replacement.

TELE MALFUNCTION

Source - MX40

Hard

MX40 malfunction or
self-test failure.

Contact Service to replace
the MX40.

TRANSMITTER OFF

Source - MX40

Hard

RF Auto Shutoff after 10
minutes of all leads off
and no SpO2 sensor
connected.

Reattach ECG leads to

patient.
Reattach SpO2 sensor.

TELE REMOVE BATT
Source - MX40

Note — For Information

Center Release L or M,
this INOP will appear as
"REPLACE BATTERY
T".

Hard,
Latched

The temperature of the
lithium-ion battery is >60o
C and the battery must
be removed.

Replace the lithium-ion

battery.
Dispose of old battery

properly.

TELE SERVICE BATT
Source - MX40

Hard

The lithium-ion battery
has exceeded the
maximum charge cycle
limit and reached the end
of its useful life.

Replace the lithium-ion

battery.
Dispose of old battery

properly.

4-20 Alarms

Alarm Text

Priority

Condition

What to do

TELE WEAK SIGNAL

Source - MX40

Soft

Patient is at outer

range of the radio

coverage area.
The MX40 is receiving

a weak signal with

high data loss from

the AP.
Condition exists for

multiple devices in a

specific area

Return patient to the

coverage area.
If patient is in close

proximity to AP, replace

the MX40. Contact

service.
The AP covering the

specific area is suspect.

Contact Service

Alarms 4-21

ECG Safety Information ........................................................................... 5-2

Measuring ECG ......................................................................................... 5-4

Connecting and Positioning ECG Electrodes ........................................ 5-5

Selecting the Primary and Secondary ECG Leads ................................ 5-6

Checking Paced Status .............................................................................. 5-7

Understanding the ECG Display............................................................. 5-8

Monitoring Paced Patients ....................................................................... 5-9

Changing the Size of the ECG Wave .................................................... 5-10

Choosing EASI or Standard Lead Placement ...................................... 5-11

ECG Configuration .................................................................................. 5-12

ECG Leads Monitored ............................................................................ 5-13

Reconstructed Leads ............................................................................... 5-15

3-Wire Placement ..................................................................................... 5-16

5-Wire Placement (Standard Mode)...................................................... 5-17

5-Wire Placement (EASI Mode) ............................................................. 5-18

6-Wire Placement ..................................................................................... 5-19

Chest Electrode Placement ..................................................................... 5-20

Monitoring during Leads Off ................................................................ 5-21

ST/AR Arrhythmia Monitoring ............................................................. 5-23

ST/AR ST Analysis Algorithm ............................................................... 5-30

QT Interval Monitoring .......................................................................... 5-33

5. ECG and Arrhythmia
Monitoring

This section covers the specifics of ECG measurement and the ST/AR
Arrhythmia, ST, and QT algorithms used for arrhythmia monitoring.

ECG and Arrhythmia Monitoring 5-1

ECG Safety Information

Warnings

Always confirm MX40 and Information Center observations with

clinical observation of the patient before administering interventions.

To avoid patient injury, assure that the patient cable is not positioned

where leads could become entangled around the patient, or cause
choking, strangulation, or inhibit circulation in extremities.

Every lead must be secured to an electrode on the patient. Conductive

parts of electrodes must not contact earth or other conductive parts.

EASI derived 12-lead ECGs and their measurements are

approximations to conventional 12-lead ECGs. As the 12-lead ECG
derived with EASI is not exactly identical to the 12-lead conventional
ECG obtained from an electrocardiograph, it should not be used for
diagnostic interpretations.

EASI lead placement is supported for adult patients only.
Ensure that the patient cable is properly connected to the MX40.
Do not mix and match electrodes of different types. In particular, do not

use electrodes of dissimilar metals. This helps ensure optimal signal
quality.

Non-manufacturer supplied accessories and supplies can corrupt the

performance of the equipment. Use only AAMI EC-12 compliant
electrodes with this device. Use of electrodes that are non-compliant
may provide erroneous results.

During complete heart block or pacemaker failure (to pace or capture),

tall P-waves (greater than 1/5 of the average R-wave height) can be
erroneously counted by the arrhythmia algorithm, resulting in missed
detection of cardiac arrest.

Caution

To protect the MX40 from damage during defibrillation, to ensure

accurate ECG information, and to provide protection against signal
noise and other interference, use only ECG electrodes and cables
specified by Philips.

Philips recommends that you change the lead label only to reflect the

physical placement of electrodes. This will ensure a match between the
monitored lead and the label, and prevent any possible confusion.

5-2 ECG and Arrhythmia Monitoring

Note — When switching from EASI to standard monitoring, there is a

momentary loss of data.

For Paced Patients

Warnings

The output power of the MX40 and other sources of radio frequency

energy, when used in the proximity of a pacemaker, can be sufficient to
interfere with pacemaker performance. Due to the shielding effects of
the body, internal pacemakers are somewhat less vulnerable than
external pacemakers. However, caution should be exercised when
monitoring any paced patient.

In order to minimize the possibility of interference, position electrodes,
electrode wires, and the MX40 as far away from the pacemaker as
possible.

Consult the pacemaker manufacturer for information on the RF
susceptibility of their products and the use of their products with the
MX40. See the IntelliVue Information Center Instructions for Use for
additional information on monitoring paced patients.

When an external pacemaker is being used on a patient, arrhythmia

monitoring is severely compromised due to the high energy level in the
pacer pulse. This may result in the arrhythmia algorithm's failure to
detect pacemaker non-capture or asystole.

Pacemakers that create fusion beats (pace pulse on top of the QRS

complex) cannot be detected by the monitor's QRS detector.

For paced patients who exhibit only intrinsic rhythm, the monitor can

erroneously count pace pulses as QRS complexes when the algorithm
first encounters them, resulting in missed detection of cardiac arrest.
The risk of missing cardiac arrest can be reduced by monitoring these
patients with the low heart rate limit at or slightly above the
basic/demand pacemaker rate. A low heart rate alarm notifies you when
the patient begins pacing. Proper detection and classification of the
paced rhythm can then be determined.

Note— During defibrillation, monitoring may be temporarily interrupted

or distorted. It may take several seconds for the ECG trace to reappear on
the screen. After defibrillation, the device will continue to monitor as
before; the device settings will not be affected.

ECG and Arrhythmia Monitoring 5-3

Measuring ECG

The electrocardiogram (ECG) measures the electrical activity of the heart
and displays it on the MX40 and the Information Center as a waveform and
a numeric.

In order to compare measured ECG signals, the electrodes (or patient
cables) are placed in standardized positions, forming "leads". To obtain
ECG signals optimized for use in diagnosis and patient management in
different care environments, different leadsets in varying lead placements
are used. Both standard lead and EASI lead placements can be used with
the MX40.

The Heart Rate calculation resides in the arrhythmia algorithm on the MX40
and at the Information Center. Arrhythmia analysis is always turned on for
telemetry patients. Arrhythmia analysis is either Basic or Enhanced,
depending on the product configuration.

5-4 ECG and Arrhythmia Monitoring

Connecting and Positioning ECG Electrodes

Correct lead placement is always important for accurate diagnosis.
Especially in the precordial leads, which are close the heart, QRS
morphology can be greatly altered if an electrode is moved away from its
correct location. Each electrode is color-coded. Use the placement diagrams
available on the display of the MX40 and in this section for guidance.
Additional lead placement information is available in the Online Help at the
IntelliVue Information Center.

When placing electrodes on the patient, choose a flat, non-muscular site
where the signal will not be impacted by either movement or bones.

Philips recommends that electrodes be changed every 24 hours.

In addition to correct positioning of the electrodes, optimal skin preparation
prior to electrode placement will help ensure a clear signal for diagnosis.

1 Prepare the patient’s skin. Good electrode-to-skin contact is important

for a good ECG signal, as the skin is a poor conductor of electricity.

Select sites with intact skin, without impairment of any kind.
Clip or shave hair from the site as necessary.
Wash site with soap and water, leaving no soap residue.

Note — Philips does not recommend using ether or pure alcohol,

because they dry the skin and increase the resistance.

Dry thoroughly.
Use ECG skin preparation paper (abrasive) to remove dead skin

cells and to improve the conductivity of the electrode site.

2 Check electrodes for moist gel, and attach to the clips. If you are not

using pre-gelled electrodes, apply electrode gel to the electrodes before
placement.

Note — Gel must be moist to provide a good signal.

3 Place the electrodes on the patient according to the lead placement you

have chosen (see the electrode placement diagrams following). Place the
edge down, then "roll down" the rest of the pad. Press firmly around the
adhesive edge toward the center.

4 Attach the patient cable to the MX40. An ECG waveform and numeric

appear on the monitor display.

ECG and Arrhythmia Monitoring 5-5

Selecting the Primary and Secondary ECG Leads

The MX40 uses the primary and secondary lead selected at the Information
Center to compute HR and to analyze and detect cardiac arrhythmias. They
are also available for recordings and for display on the Information Center.

The secondary lead is used if your device is configured for multi-lead
(instead of single-lead) arrhythmia analysis.

You should choose a lead as primary or secondary lead at the Information
Center that has the following characteristics:

the QRS complex should be either completely above or below the

baseline and it should not be biphasic

the QRS complex should be tall and narrow
the P-waves and T-waves should be less than 0.2 mV

5-6 ECG and Arrhythmia Monitoring

Checking Paced Status

It is important to set the paced status correctly when you start monitoring
ECG.

Note — Paced status is set at the Information Center and can only be

changed at the Information Center.

When Paced is set to Yes:

Pacer Algorithm is switched on. This means that pacemaker pulses are

not counted as extra QRS complexes.

The pacer spikes are shown in white.
The paced symbol is displayed.

When Paced is set to No and your patient has a pacemaker, pace pulses
may be counted as regular QRS complexes, which could prevent an
asystole event from being detected.

Warning

Pace pulse rejection must be switched on for paced patients by setting

Paced to Yes. Switching pace pulse rejection off for paced patients may
result in pace pulses being counted as regular QRS complexes, which
could prevent an asystole event from being detected. At
admission/discharge, always check that paced status is correct for the
patient.

Some pace pulses can be difficult to reject. When this happens, the

pulses are counted as a QRS complex, and could result in an incorrect
HR and failure to detect cardiac arrest or some arrhythmias. Make sure
that pace pulses are detected correctly by checking the pace pulse
markers on the display. Keep pacemaker patients under close
observation.

ECG and Arrhythmia Monitoring 5-7

1. Lead label of the displayed wave

2. 1 mV calibration bar

3. Pacer spikes

4. Current heart rate

5. Current heart rate alarm limits

6. EASI lead placement label (located here
when active)

Understanding the ECG Display

Your display may be configured to look slightly different.

ECG HR numeric: This is the heart rate derived from the monitored ECG.
Pacer Spikes: The pacer spikes are shown in white.

5-8 ECG and Arrhythmia Monitoring

1. Normal Beats

2. Pace
Pulses/Beats

1. Repolarization tail
(note width)

Monitoring Paced Patients

An ECG optimized for monitoring a paced patient should look like this:

You should choose a lead as primary or secondary lead that has these
characteristics:

the normal QRS complex should be either completely above or below

the baseline and it should not be biphasic. For paced patients, the QRS
complexes should be at least twice the height of pace pulses.

the QRS complex should be tall and narrow
the P-waves and the T-waves should be less than 0.2 mV.

Avoiding Pace Pulse Repolarization Tails

Some unipolar pacemakers display pace pulses with repolarization tails.
These tails may be counted as QRSs in the event of cardiac arrest or other
arrhythmias.

If you note a visible repolarization tail, choose a lead that decreases the size
of the repolarization tail.

ECG and Arrhythmia Monitoring 5-9

Changing the Size of the ECG Wave

If any of the displayed ECG waves is too small or clipped, you can change
the size of the ECG waves on the screen.

Changing the adjustment factor only changes the visual appearance of the
ECG wave on the MX40. It does not affect the ECG signal analyzed by the
algorithm.

Comparing the wave size to the 1 mV calibration bar on the ECG wave
segment can help you get an idea of the true ECG signal strength.

 To change the size of the ECG waves on the screen by

a fixed adjustment factor:

1 Touch the HR parameter.
2 In the Setup ECG menu, scroll to the second page and select Adjust

Size.

3 Select the required adjustment factor from the list.

Size X1/2 to halve the wave size
Size X1 to display the wave without zoom
Size X2 to double the wave size
Size X4 to multiply the wave size by four

5-10 ECG and Arrhythmia Monitoring

Choosing EASI or Standard Lead Placement

Choose either standard lead placement or EASI lead placement:

1 In the Setup ECG menu, select Lead Placement to toggle between

Standard or EASI.

2 Select Standard or EASI.
Note — When changing lead placement, the patient cable must be attached

to the MX40.

EASI is shown beside the 1 mV calibration bar on the ECG wave on the
display, and EASI is marked on any recorder strips and printouts.

See the sections on Lead Placement for electrode placement diagrams.

ECG and Arrhythmia Monitoring 5-11

Electrode Labels

Electrode Colors

AAMI

EASI

IEC

AAMI

IEC

RA I R

White

Red
LA S L

Black

Yellow

LL A F

Red

Green

RL N N

Green

Black

V/Va

E

C/Ca

Brown

White

Vb Cb

Brown/White

White/Blue

ECG Configuration

The MX40 supports 3-, 5-, and 6-wire patient cables. The 5-wire patient
cable can be used for either standard or EASI electrode configurations. The
MX40 detects the patient cable type attached and automatically determines
the ECG measurement and transmitted leads.

Note—The labels and colors of the ECG electrodes differ according to the

standards that apply for your hospital. The electrode placement references
and illustrations in this chapter use the AAMI labels and colors. See the
table below for additional label and color information.

Arrhythmia analysis resides in the arrhythmia algorithm on the MX40 and
at the Information Center. Arrhythmia analysis is always turned on for
telemetry patient. Arrhythmia analysis is either Basic or Enhanced
(optional).

5-12 ECG and Arrhythmia Monitoring

If you are using ...

these leads can be selected at the MX40
and the Information Center

3-wire

I, II, III
Sourced (raw) waves are received as:
Channel 1 = I, II, or III
Factory Default is II.

5-wire (Standard mode)

I, II, III, aVR, aVL, aVF, MCL and V
Sourced (raw) waves are received as:
Channel 1 = II
Channel 2 = III
Channel 3 = MCL
Factory Defaults are II, V, III.

5-wire (EASI mode)

I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5,
V6

In EASI mode, the sourced (raw) waves
are received as:

Channel 1 = Vector 1 (A-I)
Channel 2 = Vector 2 (A-S)
Channel 3 = Vector 3 (E-S)
Factory Defaults are II, V2, III, V5.
Arrhythmia monitoring is performed only on

the primary and secondary leads selected
at the Information Center, although you can
view and perform ST analysis on all 12
EASI derived leads.

ECG Leads Monitored

Depending on the patient cable connected to the MX40, a different set of
viewable leads are available at the MX40 and the Information Center. The
MX40 can source up to four raw ECG waves to the Information Center.

ECG and Arrhythmia Monitoring 5-13

If you are using ...

these leads can be selected at the MX40
and the Information Center

6-wire

I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5,
V6, V7, V8, V9, V3R, V4R, V5R.

Sourced (raw) waves are received as:
Channel 1 = II
Channel 2 = III
Channel 3 = Va
Channel 4 = Vb
Factory Defaults are II, Va = V2, III,Vb =

V5.
The two chest leads, Va and Vb, can be

placed on the patient in any of the V lead
positions (V1 through V9, V3R, V4R, V5R).
Lead assignment is available at the
Information Center. When unassigned, the
chest leads use the defaults.

Note— The lead label assigned to Vb

cannot be selected for Va even though Vb
does not appear to be used.

When display of the pleth wave is enabled
at the Information Center, the second chest
lead (Vb) is not available for monitoring.

5-14 ECG and Arrhythmia Monitoring

ECG Lead

Clinical Calculations
in terms of
electrodes

3-wire

5-wire
Standard

6-wire

I I I

LA-RA
II

(default)

II (default)

II
(default)

LL-RA

III

III
(default)

III
(default)

LL-LA

-

MCL

V-LA, where V=C

-

aVR

aVR

RA-(LA+LL)/2

-

aVL

aVL

LA-(RA+LL)/2

-

aVF

aVF

LL-(LA+RA)/2

-

V (default)

V-(RA+LA+LL)/3,
where V=C

Va

Va-(RA+LA+LL)/3,
where Va=V2 (default)
position

Vb

Vb-(RA+LA+LL)/3,
where Vb =V5
(default) position

Reconstructed Leads

Reconstruction of leads from the sourced wave is defined by the
calculations in the following table. EASI reconstructed leads are a linear
combination of all three raw EASI leads

ECG and Arrhythmia Monitoring 5-15

1. RA - directly below the clavicle
and near the right shoulder

2. LA -directly below the clavicle
and near the left shoulder

3. LL - on the left lower abdomen

3-Wire Placement

5-16 ECG and Arrhythmia Monitoring

1. RA directly below the clavicle and near
the right shoulder

2. LA directly below the clavicle and near
the left shoulder

3. RL on the left lower abdomen

4. LL on the right lower abdomen

5. V on the chest, the position depends
on your required lead selection. The
typical position is V1, although this
may vary according based on your
hospital’s protocol.

V1 on the fourth intercostal space at the

right sternal border

V2 on the fourth intercostal space at the

left sternal border

V3 midway between the V2 and V4

electrode positions

V4 on the fifth intercostal space at the

left midclavicular line

V5 on the left anterior axillary line,

horizontal with the V4 electrode position

V6 on the left midaxillary line, horizontal

with the V4 electrode position

5-Wire Placement (Standard Mode)

ECG and Arrhythmia Monitoring 5-17

1. E (V) on the lower sternum at the level of
the fifth intercostal space

2. A (LL) on the left midaxillary line at the
same level as the E electrode

3. S (LA) on the upper sternum

4. I (RA) on the right midaxillary line at the
same level as the E electrode

5. N (Reference) can be anywhere, usually
below the sixth rib on the right hip

Make sure that the S and E electrodes line up vertically on
the sternum, and that the I, E and A electrodes align
horizontally.

5-Wire Placement (EASI Mode)

5-18 ECG and Arrhythmia Monitoring

6-Wire Placement

For a 6-lead placement use the positions from the 5-lead diagram above but
with two chest leads. The two chest leads, Va and Vb, can be positioned at
any two of the V1 to V6 positions shown in the chest electrode diagram
below.

The default position of Va - the brown lead - is at the V2 position.

The default position for Vb - the brown/white lead - is at the V5 position.

The lead placement for the Va and Vb lead labels must be appropriate. If
your unit uses other precordial leads for Va and Vb, they may be assigned
in Unit Settings at the Information Center as defaults for your whole unit,
or you may need to assign the new positions on a per-patient basis in the
Patient Window at the Information Center.

Selecting Positions of Va and Vb Chest Leads

The two chest leads for the 6-lead placement can be positioned at any two
of the V1 to V9 and V3R, V4R and V5R positions. Select the positions you
have used in the Patient Window at the Information Center, so that the
chest leads will be correctly labeled.

ECG and Arrhythmia Monitoring 5-19

V1 on the fourth intercostal space at the
right sternal border

V2 on the fourth intercostal space at the
left sternal border

V3 midway between the V2 and V4
electrode positions

V4 on the fifth intercostal space at the left
midclavicular line

V5 on the left anterior axillary line,
horizontal with the V4 electrode position

V6 on the left midaxillary line, horizontal
with the V4 electrode position

V3R-V6R on the right side of the chest in
positions corresponding to those on the
left

VE over the xiphoid process
V7 on posterior chest at the left posterior

axillary line in the fifth intercostal space
V7R on posterior chest at the right

posterior axillary line in the fifth intercostal
space

Chest Electrode Placement

For accurate chest electrode placement and measurement, it is important to
locate the fourth intercostal space.

 To locate the fourth intercostal space:

1 Locate the second intercostal space by first palpating the Angle of Lewis

(the little bony protuberance where the body of the sternum joins the
manubrium). This rise in the sternum is where the second rib is

5-20 ECG and Arrhythmia Monitoring

attached, and the space below this is the second intercostal space.

2 Palpate and count down the chest until you locate the fourth intercostal

space.

Monitoring during Leads Off

ECG Fallback and Extended monitoring states are supported for the MX40
when the primary and/or secondary leads are in a "Leads Off" INOP
condition. Both of these states are entered into after 10 seconds of "Leads
Off" in an attempt to maintain monitoring and arrhythmia analysis.

ECG Fallback

ECG Fallback occurs when the primary lead is in "Leads Off" for 10 seconds
and a secondary lead is available.

Multilead Analysis

If there is a "Leads Off" technical alarm in the primary lead for > 10 seconds,
the active secondary lead becomes the primary lead. The arrhythmia
algorithm switches the leads on the display, but relearn does not occur.
When the "Leads Off" condition is corrected, the leads are switched back to
their original state.

Single Lead Analysis

For single lead analysis, if there are two leads available, the secondary lead
is made the primary lead until the "Leads Off" condition is corrected. The
arrhythmia algorithm performs a relearn using the available lead.

Extended Monitoring

If both the primary and secondary leads are in a "Leads Off" condition, the
ECG source on the MX40 will switch to any available lead. Relearning will
occur in this condition.

Fallback for EASI

If one of the derived EASI leads is in a technical alarm condition, a flat line
is displayed. After 10 seconds, the directly acquired EASI AS, EA, or AI
lead, depending on which is available, is displayed. Arrhythmia relearn is
performed with transition to or from EASI Fallback monitoring using the
available lead(s).

Relearning

Whenever there is a "Leads Off" condition for more than 60 seconds, the
arrhythmia algorithm performs a Relearn using the available leads.

ECG and Arrhythmia Monitoring 5-21

Warning

Since Relearn happens automatically, if learning takes place during
ventricular rhythm, the ectopics can be incorrectly learned as the normal
QRS complex. This can result in missed detection of subsequent events of
V-Tach and V-Fib. For this reason, you should:

1 Respond promptly to any technical alarm.
2 Ensure that the arrhythmia algorithm is labeling beats correctly.

5-22 ECG and Arrhythmia Monitoring

ST/AR Arrhythmia Monitoring

ST/AR Arrhythmia Algorithm

Indications for Use

The ST/AR Arrhythmia Algorithm is indicated for use in instances where
the clinician decides to monitor cardiac arrhythmias of adult and pediatric
patients and/or the ST segment of adult patients to gain information for
treatment, monitor the adequacy of treatment, or to exclude causes of
symptoms.

How the ST/AR Algorithm Works

ST/AR multi-lead analysis is performed on the user-selected primary and
secondary leads. If only one lead is available for multilead, ST/AR analysis
is performed on the single available lead.

Arrhythmia analysis consists of several steps:

1 The ECG signal is pre-processed to filter out baseline wander, muscle

artifact, and signal irregularities. In addition, if the Paced status = Yes,
pace pulses are detected then rejected from the processing to avoid
seeing them as QRS beats.

2 Beat detection to locate the QRS complexes for further analysis.
3 Feature measurement such as R-wave height, width, and timing.
4 Beats classification. Templates are created and are matched to incoming

beats, and the appropriate beat label is determined.

5 Rhythm and alarm detection. Beat labels are used to produce the values

and events needed to generate rhythms and alarms.

Working in parallel with beat detection and classification, a separate
detector examines continuously for ventricular fibrillation, asystole, and
noise.

The quality of the ECG signal is important for accurate arrhythmia analysis.
The section below provides guidelines for optimizing signals for
arrhythmia analysis.

For additional information on the ST/AR Algorithm, refer to the
Arrhythmia Monitoring ST/AR Algorithm Application Note,
#453564115631.

ECG and Arrhythmia Monitoring 5-23

Alarms with Basic Arrhythmia
Option

Additional Alarms with Enhanced
Arrhythmia Option

***Asystole

**Afib

***Ventricular
Fibrillation/Tachycardia

**Supraventricular Tach
***Extreme Bradycardia

**Missed Beat

***Extreme Tachycardia

**Pause

Aberrantly-Conducted Beats

As P-waves are not analyzed, it is difficult and sometimes impossible for
the monitor to distinguish between an aberrantly-conducted
supraventricular beat and a ventricular beat. If the aberrant beat resembles
a ventricular beat, it is classified as ventricular. You should always select a
lead where the aberrantly-conducted beats have an R-wave that is as
narrow as possible to minimize incorrect calls. Ventricular beats should
look different from these 'normal beats'. Instead of trying to select two leads
with a narrow R-wave, it may be easier to just select one lead and use single
lead arrhythmia monitoring. Extra vigilance is required by the clinician for
this type of patient.

Intermittent Bundle Branch Block

Bundle branch and the other fascicular blocks create a challenge for the
arrhythmia algorithm. If the QRS during the block changes considerably
from the learned normal, the blocked beat may be incorrectly classified as
ventricular, causing false PVC alarms. You should always select a lead
where the bundle branch block beats have an R-wave that is as narrow as
possible to minimize incorrect calls. Ventricular beats should look different
from these 'normal beats'. Instead of trying to select two leads with a
narrow R-wave, it may be easier to just select one lead and use single lead
arrhythmia monitoring. Extra vigilance is required by the clinician for this
type of patient.

ECG and Arrhythmia Alarm Overview

The ECG and arrhythmia alarms available depend on the arrhythmia
option enabled for your MX40.

Basic arrhythmia alarms are listed below along with the alarms provided
with the optional Enhanced Arrhythmia.

To check your enabled settings, view the Standby screen.

5-24 ECG and Arrhythmia Monitoring

Alarms with Basic Arrhythmia
Option

Additional Alarms with Enhanced
Arrhythmia Option

***Ventricular Tachycardia

**Irregular HR

**High heart rate

**Ventricular Rhythm

**Low heart rate

**Run PVCs High

**Pacer Not Capture (if Pacing
set to On)

**Pair PVCs

**Pacer Not Pacing (If Pacing set
to On)

**R-on-T PVCs

**PVCs/min HIGH (PVC >
limit/min)

**Ventricular bigeminy
**Ventricular trigeminy

**Non-sustain VT

**Multiform PVCs

1. Extreme Brady Limit

2. Low Limit

3. High Limit

4. Extreme Tachy Limit

5. Extreme Brady (D value)

6. Extreme Tachy (D value)

Note — The ST/AR Arrhythmia Algorithm operates and generates alarms

independently at both the MX40 and the Information Center. Therefore,
you may see slight differences between the two, even though the alarm
settings and limits are the same.

Using ECG Alarms

At the Information Center, ECG alarms can be switched on and off and the
high and low alarm limits changed just like other measurement alarms, as
described in the Alarms chapter. Special alarm features which apply only to
ECG are described here.

Extreme Alarm Limits for Heart Rate

The extreme rate alarms, Extreme Tachy and Extreme Brady, are set at the
Information Center by adding a set value (the D value) to the high and low
alarm limits.

ECG and Arrhythmia Monitoring 5-25

You need to know which value has been configured for your monitor.
Changing the high and low alarm limits automatically changes the extreme
alarm limits within the allowed range.

Arrhythmia Alarm Settings

Some arrhythmia alarms can be turned off at the Information Center. They
are:

Non-Sustain VT, Vent Rhythm, Run PVCs, Pair PVCs, R-On-T PVC,
V.Bigeminy, V.Trigeminy, Multif.PVCs, Pause, SVT, HR High, HR Low
Irregular HR, Missed Beat, PVCs/min, Pacer Not Capture, Pacer Not

Pacing, Asystole and Afib.

It is also possible to turn all yellow arrhythmia alarms off at the Information
Center.

Alarms that have been turned off at the Information Center will appear as
off in the Arrhythmia menu of the MX40, but they are not accessible, nor
can you change limits locally.

Yellow Arrhythmia Alarms

Yellow arrhythmia alarms are short yellow alarms specific to
arrhythmia-related patient conditions. Depending on your Information
Center configuration, they may be shown with one or two stars. The heart
rate alarms (High HR and Low HR) can be configured as short yellow or
standard yellow alarms. When they are standard yellow alarms they exist
independently of the other arrhythmia alarms and no timeout periods
apply.

Warning

When arrhythmia analysis is on, all yellow ECG and arrhythmia alarms are
short yellow alarms (one-star). This means that the alarm tones (if volume
is on) are active for six seconds only, after which the blinking numeric and
the alarm message remain for up to three minutes. The only exception to
this are the HR High and Low alarms which can be configured as standard
yellow alarms. Red alarms behave as usual.

Viewing Arrhythmia Waves

 To review arrhythmia beat labels:

1 Go to the Setup ECG menu.

5-26 ECG and Arrhythmia Monitoring

2 Select Arrhythmia.
3 Change Annotate Arrhy from Off to On. Beat labels will be annotated

above the ECG wave and Delayed will appear beside it.

 To return to the normal ECG primary lead display:

1 Select Annotate Arrhy.
2 Change to Off.
3 Exit from the Setup ECG menu.

Arrhythmia Beat Labels

Arrhythmia beat labels tell you how the monitor is classifying beats.

N = Normal
V = Ventricular Ectopic
S = Supra-ventricular Premature
P = Paced
' = Pacer spike
" = Biventricular Pacer Spike
L = Learning patient's ECG
A = Artifact (noisy episode)
? = Insufficient information to classify beats
I = Inoperative condition (e.g., LEADS OFF)
M = Pause or missed beat

Learning

The arrhythmia system’s goal is to learn the patient’s normal complexes so

it can differentiate abnormal beats. This "learning" process uses the 15 first
valid beats (for example, free from noise) encountered during the learning
phase.

While the system is learning the complex, the delayed arrhythmia wave
displays the beat label "L".

ECG and Arrhythmia Monitoring 5-27

Learning Phase

A learning phase involves the system learning the patient’s dominant
complexes. During a learning phase:

Alarm timeout periods are cleared.
Stored arrhythmia templates are cleared.
Asystole, Vfib, and HR alarms (when there are enough beats to

compute the HR) are active.

All other alarms are not active.

Single Lead Analysis

If single lead analysis is selected, the arrhythmia system begins learning
whenever:

ECG monitoring is initiated.
The Relearn key is activated (see Initiating Arrhythmia Relearning

Manually p. 5-29).

The ECG Lead or Lead Label is changed manually, or when Fallback

occurs (see ECG Fallback p. 5-21).

A "LEADS OFF" INOP condition (that has been active for >60 seconds)

ends.

When the MX40 re-associates with the Information Center.

Multilead Analysis

If multilead analysis is selected, the arrhythmia system begins a learning on
both leads whenever:

ECG monitoring is initiated.
The Relearn key is activated (see Initiating Arrhythmia Relearning

Manually p. 5-29).

There has been a Leads Off INOP condition (that has been active for >60

seconds) for both leads, and the condition ends in either lead.

When the MX40 re-associates with the Information Center.

Multilead Analysis With Changes in One Lead

Since the arrhythmia system uses more than one lead for analysis, if there is
a change in one lead, the system does a relearn only on the affected lead.
This happens whenever:

An ECG lead or label is changed.

5-28 ECG and Arrhythmia Monitoring